General Office Survey

General Office Patient Survery

Age *

Gender *

Male Female

Ease of getting care:

* Indicates required field

Ability to get in to be seen *

Convenience of office location *

Hours office is open *

Prompt return on calls *

Waiting:

Time in waiting room *

Waiting for tests to be performed *

Time in exam room *

Waiting for test results *

Staff:

Friendly and helpful to you *

Answers your questions *

Payment:

What you pay *

Collection of payment *

Explanation of charges *

Facility:

Neat and clean building *

Ease of access *

Privacy *

Ease of finding where to go *

Comfort and safety while waiting *

Confidentiality:

Keeping your person information private *

The likelihood of referring your friends and relatives *

What do you like best about our office? *

What do you like least about our office? *

Suggestions for improvement *

Submit