NID Patient Satisfaction Survey

In our continued commitment to improve communication and patient care, we have created the following survey. Your issues, concerns and feedback are very important to us. Thank you for helping us continue to provide quality care and services.

Please rate your satisfaction level with each of the following statements.

1= Always

2= Usually

3= Sometimes

4= Rarely

5= Never

You feel well cared for in our office

The quality of our clinical treatment meets or exceeds your expectations

You can schedule appointments conveniently

You are seen within a timely manner for your appointment

Our staff is attentive and courteous

Our doctor is caring and considerate

Your questions and concerns are addressed to your satisfaction

Additional Comments and Suggestions:

Please take a moment to refer a family or friend to our practice:

Name

First NameLast Name

E-mail

Phone Number

Area CodePhone Number

Thank you for your time. Our goal is to provide outstanding clinical care and excellent customer service to you and your referrals.