Customer Satisfaction Survey
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- Name *FirstLast
- Date of Visit *MM/DD/YYYY
- Location *BeavercreekCentervilleDayton (Main)Dayton (St.Elizabeth)SpringfieldVandalia
- Doctor *Dr. Adam ThomasDr. Belinda DotterDr. Nicole Rahn
- Please rate the following accordingly.
- 1. The cleanliness and comfort of the office itself *ExcellentGoodFairPoor
- 2. The friendliness and courtesy of our staff *ExcellentGoodFairPoor
- 3. Discussion of diagnosis and treatment options so that you understood your choices *ExcellentGoodFairPoor
- 4.The attitude and conversation between our physician and you *ExcellentGoodFairPoor
- 5.The overall satisfaction with your physician *ExcellentGoodFairPoor
- 6. The waiting time in our reception area prior to being seen by the doctor *0-5 minutes6-10 minutes10-15 minutes16+ minutes
- 7. The waiting time in the exam room prior to being seen by the doctor *0-5 minutes6-10 minutes10-15 minutes16+ minutes
- 8. Your overall satisfaction with our practice. *ExcellentGoodFairPoor
- You are our best judge. Please tell us how we can improve to better meet your needs. *
- Additional Comments about practice or customer service *This space allows you to express yourself in any way that you like in regards to the Community Foot Specialists.