Family
Friend
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Managed Care Company
Other

2. How long did you have to wait to get an appointment with the physician?

Same Day
24 hours
2-5 Days
Other

3. Was the appointment scheduler pleasant and courteous?

Yes
No, explain

4. Were you given accurate directions to the clinic?

Yes
No, Explain

5. Were your check-in and check-out procedures handled courteously and efficiently? 

Yes
No, Explain

6. What was your average waiting time at the clinic?

5-10 minutes
15-20 minutes
30 minutes
Other

7. Was the care provided by the physician satisfactory?

Yes
No, Explain

8. Were all of your questions answered courteously and efficiently by the staff and the physician?

Yes
No, Explain

9. How was your visit to the clinic overall?

Poor
Fair
Good
Excellent

10. Would you recommend this clinic to your family and friends?

Yes
No, Explain

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Your participation in this survey is greatly appreciated!