Printable Office Survey

Your Visit Were you happy with our back office assistant Very Satisfied Satisfied Unsatisfied Did you like the comfort and appearance of the exam room Very Satisfied Satisfied Unsatisfied Were you happy with your doctor s encounter Very Satisfied Satisfied Unsatisfied Your overall satisfaction with your care Very Satisfied Satisfied Unsatisfied Your overall satisfaction with your visit Very Satisfied Satisfied Unsatisfied How long did you wait in the exam room before the doctor visit No Wait Minutes: Would you recommend Partners in Health to a friend or family Yes No -------------------------------------------------------------------------------- Calling our office Was the line answered quickly Yes No Was the receptionist friendly and helpful when you called Yes No Was the phone message easy to understand Yes No N/A How long did it take to receive a call back for non-urgent messages Hours/ Days Website Do you like our website Very Satisfied Satisfied Unsatisfied Is it easy to navigate Yes No What improvements would you recommend You are welcome to submit anonymous responses by fax or US mail..