Patient Care Survey

You are very important to us and we are interested in knowing how you feel about our practice and the quality of care you receive by the doctor and staff. Your honest feedback is the key in helping us continue to improve our services. Please take a moment to complete this questionnaire.

1. Do we answer the phone promptly and politely?

2. Are you kept on hold too long?

3. Are all of your questions answered satisfactorily?

4. Do we see you on time?

5. Is our reception & clinical area clean and comfortable?

6. Are emergencies (during & after hours) handled promptly?

7. Are you greeted pleasantly upon arrival?

8. Are you treated with compassion and respect by our staff & Doctor?

9. Were the treatment plan and financial options adequately explained?

10. Would you refer your friends and colleagues to our office?

11. Are you pleased with the results you are seeing?

12. When your appointment is over, do you have a good understanding of the progress of your treatment?

If you answered no or poor above, please explain so we can improve.

What do you like best about our office?

What do you like least about our office?

Can we use your testimonial in print and/or on the website?

Testimonial (please include your name if you like)