Name (Optional):
City or Town of Residence:
Date of your visit:
Location:
Provider:
Did you find the information you were looking for on our website?
Was the overall website appearance pleasing?
Was the website easy to navigate?
Is there anything we could do or add that would make the website a better experience or more useful?
When you called our office was the phone system easy to use? If not what could have been better?
How long did you wait on hold before someone answered your call?
When you scheduled an appointment, was the person who answered the phone friendly, helpful, professional?
Were we able to meet your needs for an appointment time?
Did you receive a reminder call from an automated service?
If you did, was the automatic reminder complete in the information given regarding your appointment?
Was the automatic reminder call clear and easy to understand?
If you spoke with the triage nurse was she friendly, helpful, professional?
Did the triage nurse answer your question clearly and completely?
If you had to receive a call back from the triage nurse how long did you have to wait?
If you were seen in our office was the receptionist friendly, helpful, professional?
How long did you wait in the waiting room?
How long did you wait in the exam room?
Was the nurse who brought you back friendly, helpful, professional?
Did the nurse answer any questions or concerns you had?
Was the provider (doctor) friendly, helpful, professional?
Did the provider answer any questions or concerns you had?
Please rate today’s experience on a scale of 1-10: Poor=1 to Excellent= 10
Please make any comments or suggestions here. Please comment on any “no” answers.
Please type the letters you see below:
This might take a minute
