Patient Resources

Patient Satisfaction

Personal Information

Use a permanent address where you can receive mail.

Are you a new patient?


We'll always let you know about important changes, but you pick what else you want to hear about.

Did you feel your appointment was scheduled within a reasonable time?
Did you find our office to be conveniently located with proper signage?
Were you happy with our waiting room and wait times?
If you answered no to the above question, why?

Provider and Staff Feedback

Please rate our staff’s professionalism, courteousness, and efficiency in each area of your visit.

When scheduling your appointment
At the check-in process when you arrived
During the intake process with the medical assistant or nurse
With the provider’s medical secretary
When calling our office for prescription refills, test results, billing, or anything else

Provider and Staff Feedback Continued

During the time with your provider, please rate the following:

With obtaining the proper dignity and respect from your provider
With the ability to ask questions to your provider
With the amount of time spent with your provider
With instructions regarding medication/follow–up care
With the clarity of explanation/answers from your provider

Please rate the following items as they relate to your care

The effectiveness of our health information, instructions and hand-outs
The ability to return your calls in a timely manner
With getting advice or help during office hours
With getting advice or help after office hours
With us obtaining/keeping your confidentiality

Wrap Up Questions

Additional comments regarding any of the questions above, your care, or your visit:
If there is one thing you could choose to improve our services, what would that one thing be
What would you tell your friends and family about our practice and services

Thank you, we appreciate your time!