link to our home page
link to mission page
link to our doctor page
link to our staff page
link to insurance plans page
link to patient information page
link to page with downloadable forms
link to page showing our survey
link to page showing our reviews
link to page giving our office hours
link to page showing our location
link to our contact page
Please Select Yes or No
Date of Visit
1. The Front Office Staff was warm, friendly and professional?
Yes No

2. I was able to secure an appointment time that met my need?
Yes No

3. The lighting, temperature and general surroundings were comfortable to you?
Yes No

4. The office visit began in a reasonable amount of time, or an explanation was given for a longer wait time?
Yes No

5. The back office Medical Assistant was attentive to your reason for visit and professional in her care of you?
Yes No

6. During my time with the doctor I felt he:

A. Listened to me
Yes No

B. Addressed the reason for the visit
Yes No

C. Adequately explained his decisions for my care
Yes No

7. How would you rate your visit today?
Excellent Good Fair Poor

How might we have improved your experience on the day of your visit?
Additional Comments:
Name (optional)