PATIENT SATISFACTION SURVEY
Instructions: Please select one Response for each of the following questions:
1. How was your overall experience during your procedure?
Excellent
Very Good
Average
Not So Good
2. Would you recommend this practice to your family and friends?
Yes
No
Not Sure
3. Did our team greet you promptly?
Yes
No
Do'nt Recall
4. Did you feel that our team was caring and compassionate?
Yes
No
Do'nt Recall
5. Were our prep instructions clear and complete?
Yes
No
6. Did you visit our web site?
Yes
No
Please comment on anyone you met during your visit, things we could change, or other ways we can make you feel more comfortable
What kind of comment is it?
General
Suggestion
Complaint