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Please fill in a value for the following field(s):
Your Name:
Were you able to schedule an appointment that was convenient for you?


If no please explain:
Was the receptionist friendly and attentive?


If no please explain:
What are your expectations when you visit a physician?
Please rate how you perceived the physician's interest in you as a person




Please rate how you perceived the nurse's interest in you as a person.




Please rate how you perceived the staff interest in you as a person.




Were your questions answered adequately?


If no, how could this have been improved?
Did you receive adequate assistance from the billing office?


If no, how could this have been improved?
Please rate the appearance of the facility.




Please evaluate YOURSELF for:
a. taking your prescribed medications




b. following the physician's or nurse's advice




Overall, how would you consider your experience at the Office?




If not please explain:
We welcome and encourage any additional comments you may have. All comments, whether positive or negative, are appreciated.
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