Patient Satisfaction Survey Please enable JavaScript in your browser to complete this form.1. How easy was it to schedule an appointment? *Very easy Easy Difficult2. Upon arrival, how would rate your experience with our administrative staff? *Friendly/HelpfulPleasantRudeNot acknowledgedNo receptionist3. How comfortable was our waiting area? *Very comfortable AdequateVery uncomfortable4. For your scheduled appointment, were you seen: *Before your appointmentOn timeJust afterLong afterI was late5. Were your financial obligations explained to you? *YesNo Not Applicable6. Were the instructions regarding the use and care of your treatment useful? *Very usefulSomewhat usefulNot usefulI didn’t get instructions7. Were you instructed in the purpose and function of the treatment(s)? *YesNoI don’t remember8. Were you instructed in the proper maintenance of the treatment(s)? *YesNoI don’t remember9. Were you instructed about the potential risks, benefits and precautions associated with the treatment(s)? *YesNoI don’t remember10. Were you instructed on how to inspect your treated areas for signs of problems? *YesNoI don’t remember11. Additional comments: 12. Would you like for us to contact you? If so, please provide your name and phone number.WebsiteSubmit
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