Satisfaction Survey

To Our Valued Patients,

You are very important to us and we are interested in knowing how you feel about our practice — the contact you have with us, the quality of care you receive and the manner in which you are treated by our staff. Your candid comments are the key to helping us continually improve our services. Please take a moment to complete this questionnaire.

Check The Office You Are Providing Feedback On:	Gainesville Hoschton
Check One: 1=Strongly Agree or 4=Strongly Disagree	1	2	3	4
1. Do we answer the phone promptly and politely?
2. Are you kept on "hold" too long?
3. Are all of your questions answered satisfactorily?
4. Do we return your calls promptly?
5. Do we see you on time?
6. Is our reception area clean and comfortable?
7. Do we give you complete information regarding insurance coverage?
8. In an emergency, is it easy for you to get in touch with our office?
9. Are you greeted pleasantly upon arrival?
10. Does our staff seem genuinely interested in you?
11. Are you treated with compassion and respect?
12. Are the doctor and staff attentive to your needs and concerns?
13. Does our staff spend adequate time with you?
What do you like best about our office? Comments:
What do you like least about our office? Comments:
Testimonial (Please include your name if you would like). Comments:
Are you referring your friends and colleagues to our office?	Yes		No
Are you pleased with the results you are seeing?	Yes		No
Are our parking facilities adequate?	Yes		No
Is our office easy to find?	Yes		No
Can we use your testimonial in print and/or on the website?	Yes		No
Email Address (optional):
Verification Code (case sensitive):