How are we doing?

We are committed to providing you with the best possible care. We appreciate your feedback which will be fully reviewed by our management team to assist us in further improving our service to you.

All responses will be kept confidential and anonymous. We thank you for taking the time to let us know your opinion and feedback about our services and staff.

Your age *

Your Gender *

Female

Male

Date of appointment *

Month

Day

Year

Ratings and Feedback *

	Great	Good	Neutral	Fair	Poor
Staff is friendly *	Staff is friendly - Great	Staff is friendly - Good	Staff is friendly - Neutral	Staff is friendly - Fair	Staff is friendly - Poor
Overall satisfaction with our services *	Overall satisfaction with our services - Great	Overall satisfaction with our services - Good	Overall satisfaction with our services - Neutral	Overall satisfaction with our services - Fair	Overall satisfaction with our services - Poor
Hours of operation *	Hours of operation - Great	Hours of operation - Good	Hours of operation - Neutral	Hours of operation - Fair	Hours of operation - Poor
Staff is knowledgeable *	Staff is knowledgeable - Great	Staff is knowledgeable - Good	Staff is knowledgeable - Neutral	Staff is knowledgeable - Fair	Staff is knowledgeable - Poor
Appointment availability *	Appointment availability - Great	Appointment availability - Good	Appointment availability - Neutral	Appointment availability - Fair	Appointment availability - Poor
Time in waiting room *	Time in waiting room - Great	Time in waiting room - Good	Time in waiting room - Neutral	Time in waiting room - Fair	Time in waiting room - Poor
Convenience of locations *	Convenience of locations - Great	Convenience of locations - Good	Convenience of locations - Neutral	Convenience of locations - Fair	Convenience of locations - Poor

Comments, feedback and suggestions are always welcome

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How are we doing?