Patient Satisfaction Survey

PATIENT SATISFACTION SURVEY

Contact Us

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.  All responses are confidential and anonymous.

Thank you for your time.


Please Choose how well you thing we are doing in the following areas:

Great - 5 Good - 4 OK - 3 Fair - 2 Poor -1


Ease of getting Care:

5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1

Waiting:

5
4
3
2
1
5
4
3
2
1
5
4
3
2
1

Provider: (Physician, Nurse Practitioner)

5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1

Medical Assistant:

5
4
3
2
1
5
4
3
2
1

Front office Staff/Care Coordinator:

5
4
3
2
1
5
4
3
2
1

Billing office Staff:

5
4
3
2
1
5
4
3
2
1

Facility:

5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
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