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Date                                                                
With whom did you have your visit today?    
Which office did you visit?  
 
1. When you called for your appointment, was your call handled in a timely and professional manner?
2. When you checked in for your appointment, were you treated in a professional manner?
3. Upon checking out at the Business Office, were you treated in a professional manner?
4. Were our fees/financial/insurance policies clearly explained to you?
5. During your visit did the Doctor listen to and answer your questions clearly?
6. Did you feel the Doctor spent enough time with you during your visit?
7. Would you refer our office to family or friends?
8. Have you visited our website?
9. How did you hear about our office?  
10. Do you have any other suggestions or comments which may help us improve or expand the services we provide?
 
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