Thanks you for taking the time to complete our survey. Please feel free to comment on your visit, as well as giving us feedback about our staff. Any comments you choose are sent directly to Dr. Jones and are kept strictly confidential. We appreciate you helping us become better in the future.

Patient name:
E-mail:
How would you rate your overal visit?
Excellent    Very Good    Average   Not So Good
Were your financial options explained to you to your satisfaction?
Yes    No    No, I already understand my financial options.
Did you have to wait over 10 minutes past your appointment time to be seated? If so how long?
No    10 - 20 Minutes    20 - 40 Minutes    Over 40 Minutes
Did the staff greet you properly and call you by name?
Yes    Not Really    I don't recall
Would you refer your friends and family to us?
Yes    No    I am not sure
Please comment on how we could make your visit better, new services you would like to see, or other ways we can make you feel more comfortable.



    


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