PB-JDO_PatientSurvey

The quality of your care is our top concern. To help us continually improve our quality of service, please take a moment to provide us with your feedback..

Once you have completed the survey, simply press on the submit button.

How would you rate your overall experience with our practice?

Please rate the following (scale of 1 to 5, with 5 being best):
(1 – Poor 2- Fair 3-Good 4- Very Good 5-Excellent)

Phone manners of our staff

Convenience of your appointment time

Greeting upon arrival

Helpfulness of our staff

Sensitivity and attentiveness of doctor and staff

Explanations provided/questions answered?

Do you feel positive enough about our practice to refer family and friends?

Yes

Please comment on anything regarding our service that we might change to make your future experiences with us even more positive.

Name (optional):

May we share your comments with others?

Yes

May we use your comments for future marketing materials?

Yes

Disclaimer: If you register, make an appointment or submit any other information online, all your information is transmitted securely and is held in strictest confidence, adhering to HIPAA guidelines and protecting your privacy.