1. Which office location where you seen in today?
2. Are you a patient?
3. Please let us know your age group.
4. How did you find about us.
5. Ease of Scheduling an appointment
6. Please rate the personal manner of our Staff
7. Length of waiting time at our office
8. Please rate the personal manner of our doctor.
9. Please rate the personal manner of our nurses.
10. Satisfactory Explanation of Diagnosis and Treatment
11. Will you recommend our practice to your family and friends?
12. Please respond to how you agree with the following statements:
13. Please use the space below to add any comments you may have.