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Rate Our Practice

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving these services.  Just fill out the fields below and submit. All responses will be kept confidential and anonymous.

Or, download the printable PDF patient satisfaction survey. Just download, print, fill out and drop off at your next office visit. Thank you for your time.

Your Age:
Your Doctor:
Ease of getting care Great Good OK Fair Poor
Ability to get in to be seen
Hours Center is open
Convenience of Center’s location
Prompt return on calls
Waiting Great Good OK Fair Poor
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results
Provider (Physician, Dentist, Physician Assistant, Nurse Practitioner) Great Good OK Fair Poor
Listens to you
Takes enough time with you
Explains what you want to know
Gives you good advice and treatment
Nurses and Medical Assistants Great Good OK Fair Poor
Friendly and helpful to you
Answers your questions
All Others Great Good OK Fair Poor
Friendly and helpful to you
Answers your questions
Payment Great Good OK Fair Poor
What you pay
Explanation of charges
Collection of payment/money
Confidentiality Great Good OK Fair Poor
Keeping my personal information private
Referral Great Good OK Fair Poor
The likelihood of referring your friends and relatives to us
Do you consider this center your regular source of care?
Yes
No
What do you like best about our center?
What do you like least about our Center?
Suggestions for improvement?
Email:

Thank you for completing our survey!