Physician Office Survey

PLEASE COMPLETE AFTER YOUR APPOINTMENT

Please help us care for you by providing feedback about your experience with our office and staff.  This feedback helps us continually monitor or change our systems to serve you better.







Before Your Visit: How would you rate the following:


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At the time of your visit:


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10 minutes or less10-20 minutesmore than 20 minutes

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ExcellentVery GoodGoodFairPoorDoes Not Apply

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ExcellentVery GoodGoodFairPoorDoes Not Apply

ExcellentVery GoodGoodFairPoorDoes Not Apply

ExcellentVery GoodGoodFairPoorDoes Not Apply