Patient Satisfaction Survey

  • Patient Satisfaction Survey

  • Visit Details

  • Today’s Date
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  • Satisfaction Ratings

    We want to know how you feel about the services provided to you by our Medical, Dental, and/or Behavioral Health staff. Completion of this survey is optional, but your input is very important to us. Please return your completed survey by placing it in the receptacle in the lobby area or giving it to a staff member. Thank you for completing this survey.
  • Convenience of our location*
  • Hours we are open*
  • Ability to get an appointment*
  • Prompt return of your calls*
  • Time spent in waiting room*
  • Time spent in the exam room*
  • Time spent waiting for test results*
  • Cleanliness of the clinic*
  • Comfort and privacy in the clinic*
  • Providers – Listen to you*
  • Providers – Spends enough time with you*
  • Providers – Explains what you need to know*
  • Providers – Gives you good advice*
  • Providers – Provides good treatment*
  • Medical and Dental Assistants and all other staff – Friendly and helpful to you*
  • Medical and Dental Assistants and all other staff – Answers your questions*
  • Medical and Dental Assistants and all other staff – Are attentive to your needs*
  • The cost of our services*
  • Sliding scale fee charge*
  • If the Clinic were to add hours, which of the hours would meet your needs?
  • Should be Empty: