Customer Satisfaction Survey
Answers marked with a * are required.
 
 
Thank you for taking the time to complete this survey.  Our survey is completely anonymous.  Our goal is for our patients to provide feedback to us, good or bad, in order for us to improve our care to you.  Please take the time to consider all aspects of your care including initial phone call, initial visit, surgery, and follow-up care.  Comment boxes are available after each question to clarify your response or add additional information.  If this survey does not suit your needs, please feel free to address your concerns in the open boxes at the end of the survey or you may contact us directly.  Once again, thank you.
 
 
 
1. What is your overall satisfaction with our office? *
      
 
 
 
2. Please tell us why you feel that way.
 
 
 
3. How likely are you to recommend our office to a friend or family member?
      
 
 
 
4. Please tell us why you feel that way.
 
 
 
5. How did you hear about our office? Choose all that apply.
       		 
 
 
6. If we had to choose one medium to reach the most people, what would be your preference? 
      
 
 
 
 
 

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