Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting and exceeding your needs and expectations. All responses will be kept confidential and anonymous. Thank you for your time!







Please select how well you think we are doing in the following areas:

GREAT
5

GOOD
4

OKAY
3

FAIR
2

POOR
1

 

Ease of getting care:

 

          

           

           

          

Waiting:

 

          

          

           

          

Provider:

 

          

          

          

          

Office Staff:

 

          

          

Payment:

 

          

          

          

Facility:

 

          

          

          

Website: