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(optional)
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1
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Please indicate why you chose to visit our office (may check more than one):
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Telephone Book |
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Previous experience |
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Convenient location |
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Referral from another physician |
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Other |
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2
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During your visit the following people were especially helpful:
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Billing Person |
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Check-In / Check-Out Person |
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Physician |
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Nurse |
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Physician's Assistant |
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Check-In / Check-Out
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1
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Were we polite when scheduling your appointment?
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Yes
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No
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2
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Are our office hours convenient?
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Yes
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No
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3
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Was the office easy to find?
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Yes
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No
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4
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Is our "front office" staff courteous?
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Yes
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No
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5
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Did we collect your insurance information/payment in a professional manner?
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Yes
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No
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Patient Care
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1
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Was the nursing staff attentive and courteous?
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Yes
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No
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2
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Did we make you feel comfortable during your exam?
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Yes
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No
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3
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Were you and your family treated with respect?
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Yes
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No
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4
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Did we answer your questions in a clear manner?
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Yes
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No
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5
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Did the physician spend enough time with you?
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Yes
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No
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General
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Will you return to our office for your future health care needs?
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Yes
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No
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Would you recommend our services without hesitation?
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Yes
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No
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Closing
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What can we do to make your next visit more pleasant?
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