Please select your Language: *

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1. How satisfied were you with your visit today? *

Excellent Good Average Poor

2. Convenient of the office location? *

Excellent Good Average Poor

3. Length of the time waited in the waiting room? *

Excellent Good Average Poor

4. The amount of time you waited to get an appointment? *

Excellent Good Average Poor

General Questions

Please answer the general questions about your satisfaction with this practice:

1 . How well did your doctor understand your problems? *

Excellent Good Average Poor

2 . How well did the doctor explain to you what he was doing and why? *

Excellent Good Average Poor

3 . Are you able to get appointments according to your convenience? *

Always Sometimes Never Other

3 . Are you able to get appointments according to your convenience? *

Always Sometimes Never Other

4 . Getting through to the office by phone? *

Always Sometimes Never Other

5 . For the last 12 months, was it easy to get a referral for a specialist when you felt like you needed one? *

YES NO Doesn't apply to me Other

6 . How likely are you to recommend our clinic to others? *

Very Likely Likely Unlikely Other