Patient Survey Name (optional) First Name Last Name Email * Satisfaction Survey My call was answered promptly Strongly Disagree Disagree Neutral Agree Strongly Agree Clinic hours are convenient Strongly Disagree Disagree Neutral Agree Strongly Agree Scheduling an appointment was easy and efficient Strongly Disagree Disagree Neutral Agree Strongly Agree The staff were courteous Strongly Disagree Disagree Neutral Agree Strongly Agree My wait time was minimal Strongly Disagree Disagree Neutral Agree Strongly Agree The clinical staff were courteous and helpful Strongly Disagree Disagree Neutral Agree Strongly Agree The surgeon I met with was courteous Strongly Disagree Disagree Neutral Agree Strongly Agree The surgeon I met with answered all of my questions Strongly Disagree Disagree Neutral Agree Strongly Agree I didn't feel rushed through my appointment Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Message * Thank you!
