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First Name * |
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| Last Name * |
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| E-Mail Address * |
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| Was your initial phone call handled promptly and efficiently? * |
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Yes |
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No |
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Comments |
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| Approximately how long did you wait before your call was handled?* |
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5 Min or Less |
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10 Min or Less |
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Greater than 10 Min |
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| Was your appointment scheduled to your satisfaction? * |
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Yes |
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No |
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Comments |
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| Were you greeted in a friendly, professional manner when you arrived in the office? * |
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Yes |
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No |
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Comments |
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| Did you find the appearance of our office acceptable? * |
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Yes |
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No |
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Comments |
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| Did the clinical office staff (medical assistants, x-ray technicians) conduct themselves in a professional manner? * |
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Yes |
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No |
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Comments |
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| Did your encounter with the physician meet your expectations? * |
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Yes |
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No |
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Comments |
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| Was your check-out procedure handled in a professional, efficient manner? * |
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Yes |
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No |
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Comments |
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| If you had any interaction with the Collections, Bill Pay or
Reimbursement Services Department was your experience to your satisfaction? * |
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Yes |
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No |
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Comments |
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