|
1. Did
we do anything that really stood out and you were especially happy with
that you could give us a testimonial to share? |
 |
|
|
| |
|
2. May we
print your comments on our website? |
|
|
| |
|
3. How
may we identify you when we share your comments on our website? |
|
|
| |
|
4. What
was the purpose of your visit? |
|
|
| |
|
5. Were
you a new patient to our office? |
|
|
| |
|
6.
How satisfied were you with the way our staff treated you? |
|
On a
scale of 1 to 5 where 1 represents "Most Dissatisfied" and 5 represents
"Very Satisfied." |
|
|
| |
|
7.
How satisfied were you with the way our nurses treated you?
|
|
On a
scale of 1 to 5 where 1 represents "Most Dissatisfied" and 5 represents
"Very Satisfied." |
|
|
| |
|
8. How
satisfied were you with the way Dr. Rose treated you? |
|
On a
scale of 1 to 5 where 1 represents "Most Dissatisfied" and 5 represents
"Very Satisfied." |
|
|
| |
|
9. Did
Dr. Rose spend enough time with you? |
|
On a
scale of 1 to 5 where 1 represents "Most Dissatisfied" and 5 represents
"Very Satisfied." |
|
|
| |
|
10. Were
all your questions addressed? |
|
|
|
|
|
|
| |
|
11. Would
you recommend our office to your friends and family? |
|
|
|
|
|
|
|
