(A value is required for questions in yellow.)

When you have completed the survey, please click the yes button at the bottom of the form.

1.  How did you select our medical office?: (please select all that apply)
2.  What was the primary reason for your visit?
For the next set of questions please select the best rating:
Please rate our service and support
1 very poor good excellent 4 outstanding
3.  How would you rate our hours of operation?
4.  How would you rate the ease of scheduling your appointment with our center?
5.  How would you rate the manner you were greeted by the receptionist and nursing staff?
6.  How well did your health care provider explain your diagnosis and treatment to you?
7.  How would you rate our facility to a friend or relative who needed medical care?
8.  If you were given a choice, would you return to our facility for your next medical visit?
9.  If you answered NO to the question above, is your reason for not returning due to unacceptable service at our facility?
10.  Comments; pls tell us more about your visit, if you would like to have someone contact you, please include your name and contact information.

Please click the YES button when you have completed this survey.