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910.485.1191

Patient Survey

We would love to receive your feedback! Please fill out the patient satisfaction survey below to rate your experience with us.

How did you hear about our clinic?
- Family
- Friend
- Advertisement
- Managed Care Company
- Other
Please specify:
How long did you have to wait to get an appointment with the physician?
- Same Day
- 24 Hours
- 2-5 Days
- Other
Please specify:
Was the appointment scheduler pleasant and courteous?
- Yes
- No
Please explain why:
Were you given accurate directions to the clinic?
- Yes
- No
Please explain:
Were your check-in and check-out procedures handled courteously and efficiently?
- Yes
- No
Please explain:
What was your average waiting time at the clinic?
- Less than 5 Minutes
- 5-10 Minutes
- 10-20 Minutes
- 20-30 Minutes
- More than 30 Minutes
Was the care provided by the physician satisfactory?
- Yes
- No
Please explain:
Were all of your questions answered courteously and efficiently by the staff and the physician?
- Yes
- No
Please explain:
How was your visit to the clinic overall?
- Poor
- Fair
- Good
- Excellent
Would you recommend this clinic to your family and friends?
- Yes
- No
Why not?
Suggestions or Additional Comments:
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Call 910.485.1191 or use the form below to request an appointment today.