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Your response matters!
Name
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Email
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How did you choose our practice?
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How did you choose our practice...
Friend/Relative recommended the practice
I saw the practice in the Yellow Pages.
Found you through the Search Engines.
Found you through Facebook.
Found you through Twitter.
Found you through Instagram.
Your telephone experience...
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Call answered promptly.
Easy to make an appointment.
I was referred to the website to fill out forms ahead of time.
I was placed on hold too long.
I was offered to be called back if needed.
I did not phone.
Impression of Receptionist (Over the Phone)
*
Friendly and Attentive
Courteous
Informative
Impression of Receptionist (In Person)
*
Stood and greeted Me
Aware of purpose of visit
Seemed warm and cheerful
Gave me undividided attention
Seemed hospitable
Answered all of my questions
Impression of Reception Area
*
Comfortable
Neat & Clean
Countertops free from clutter
Retail displays are well-organized
Child-friendly
Impression of Parking Lot/Grounds
*
Clean
Found a parking spot with ease
Impression of Website
*
I visited the website
I found the website helpful & resourceful.
I like the convenience of filling out my patient forms online.
I found what I was looking for quickly and easily.
Impression of Doctor
*
Introduced himself/herself
Listened to what I said
Gave clear advice
Made me feel valued
Seemed proficient & knowledgeable
Gave me the information I needed
How likely are you to refer us to a friend or relative?
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Definitely!
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Likely
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Would not recommend
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