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Give Us Feedback!
In an effort to better serve our patients, the staff and physicians would like to invite you to offer some feedback. Please help us to prioritize which area(s) we can improve on to better take care of you.
Thank you for your time. Your opinion is very important to us!
How would you rate the following aspects of our office? Please assign a number on a scale from 1 to 10 where "1" represents "Needs a lot of improvement" and "10" represents "Perfect as is".
1 2 3 4 5 6 7 8 9 10
Poor Satisfactory Great
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1. Telephone System:
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2. Check-in/Registration Process:
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3. Blood Drawing Station:
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4. Check-out:
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5. Referral Process:
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6. Prescription Refill Process:
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7. Overall Opinion of Staff:
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8. Overall Opinion of Office:
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9. Level of Health Care You Receive:
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10. Website:
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11. Your Doctor (please fill in his/her name):
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Additional Comments:
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