Name: (Optional)

Which physician did you see:
Dr. Barrett
Dr. Shelton
Dr. Hobgood
Dr. Field
Dr. Johnson
Dr. Lawin
Dr. O'Mara
Dr. Ramsey
Dr. Ethridge
Dr. Almand

2. How many visits have you had with this physician:
1-2
2-4
4-8
More than 8

3.Friendliness of our operator before transferring your call:
Excellent
Very Good
Good
Fair
Poor

4. Was your call transferred to the appropriate party:
Yes
No
Did not call

5. Timeliness of our staff returning you phone calls (if you left a message):
Excellent
Very Good
Good
Fair
Poor

6. Ability to schedule an appointment that was convenient for you:
Excellent
Very Good
Good
Fair
Poor

7. Friendliness and courtesy of our office staff, i.e. check in , check out, billing department:
Excellent
Very Good
Good
Fair
Poor

8. Friendliness and courtesy of the physicians support staff, i.e. nurses, x-ray techs, cast techs:
Excellent
Very Good
Good
Fair
Poor

9. Amount of time your physician spends with you:
Excellent
Very Good
Good
Fair
Poor

10. Do you trust your physician and feel that he/she helped you understand your medical problem and the recommended treatment?
Definitely Yes
Probably Yes
Probably Not
Definitely Not

11. Would you recommend your physician to your family/friends?
Definitely Yes
Probably Yes
Probably Not
Definitely Not

12. How would you rate your overall experience at our clinic?
Excellent
Very Good
Good
Fair
Poor

Comments:

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