Give Us Your Feedback!
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Our goal is to provide you with the best possible care. We hope your experience in our office has been both comfortable and beneficial. To continue to provide the best in medical care, we ask that you take a few minutes to fill out our Patient Satisfaction Questionnaire.
1. How would you rate the convenience with which your appointment was scheduled?
2. How would you rate the courtesy and efficiency of our front office staff?
3. How would you evaluate the comfort and appearance of our lobby and waiting areas?
4. How would you rate the thoroughness of our written material and staff in preparing you for your exam?
5. How would you rate the manner in which financial or insurance arrangements were explained to you?
6. Our technicians take pride in being courteous, compassionate, and informative. How would you rate the way they treated you?
7. How would you rate the care given to you by your physician?
8. Would you recommend our clinic to others?
9. During your visit, did you find any one individual particularly courteous, informative, and considerate?
If so, who?
10. What was the best part of your visit to the clinic?
11. What do you like the least?
12. Please provide us with your suggestions on improving patient care.
Date of visit:
Name: (optional)
Thank you for your time in making these comments, please call if I can be of service.
Kent B. Bone, Administrator
(352) 735-2020 Ext. 213
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