Was your first encounter with our receptionist, cashier, and nursing staff pleasant?
Yes
No
Were the waiting room and magazines neat and orderly?
Yes
No
Was our nursing staff courteous and helpful?
Yes
No
Did the physician spend enough time with you?
Yes
No
Did you have all your questions answered?
Yes
No
Would you refer a friend to our practice?
Yes
No
How did you hear about us
Your doctor referred you to our office
A friend/relative referred you to our office
Yellow pages advertising
TV
Radio
News Paper
Your health plan (insurance company) directed you to our office
Internet
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