PATIENT SATISFACTION SURVEYPlease take a few minutes to help us evaluate our medical practice. This is important to us because we are interested in providing you with the finest quality, & the most comprehensive medical services. If you mark any answers negatively, we would especially appreciate additional comments regarding your concerns. All responses are anonymous, so please take this opportunity to respond freely. Date Format: MM slash DD slash YYYY New PatientReturning Patient1.What factors influenced your initial choice in selecting our office : Referred by another Patient Referred by a Physician Referred by family member or friend Member of HMO, PPO or other managed care plan Telephone listings or online research Other Close to home / business Please specify2.Where your phone calls handled courteously and in a professional manner?YesNo3.Where you able to make appointment easily & within a reasonable time period ?YesNo4. When you called for appointment, was the office staff helpful & courteous?YesNo5. Did you find the reception area pleasant and comfortable?YesNo6. Did the physician answer all your questions?YesNo7. Did the physician spend enough time with you?YesNo8. Did you find the examining room clean and comfortable ?YesNo9. Where you able to schedule your next visit at your convenience ?YesNo10. Did we provide adequate review or instructions after you saw the doctor?YesNoAppointment wait time: : HH MM AM PM Comments /Suggestions to improve our service