How Can We Improve? – Please let us know…

Thank you in advance for your opinion of our service. We will use your input to improve our sevices to you. On a scale of 1-5 (with 5 being excellent, 3 being average, and 1 being poor) please rate us on the following:

Please use the names of staff members, if possible.

Which doctor / nurse practitioner saw you?
What is your age range?
What type of insurance do you use?
Ability to get a timely appointment:
Courtesy and helpfullness of the reception area staff:
Courtesy and helpfullness of the nurses:
Medical care received:
The Doctor or Nurse Practitioner's explanation of your condition and helpfullness in answering questions:
Please rate the visit overall:
How many minutes did you wait, if at all, beyond your appointment time?
Would you recommend us to your family or friends?
What did you like most about us?
What can we do to improve?
How did you hear about us?
Name of person filling out this survey (optional):
May our office manager contact you to discuss your comments?
If yes, phone number where you would like to be reached:
Verification code (please enter the code shown on the image):
Verification code (please enter the code shown on the image):

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