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On your last visit you saw?

Doctor Dentist Lab Social Worker WIC

How do you feel about...
The way you were treated by the staff?

Great Good Fair Poor Doesn't Apply to my visit

The amount of time the doctor/dentist spent with you?

Great Good Fair Poor Doesn't Apply to my visit

The time it took you to see the doctor/dentist?

Great Good Fair Poor Doesn't Apply to my visit

The amount of time the doctor/dentist spent with you?

Great Good Fair Poor Doesn't Apply to my visit

The way things were explained to you?

Great Good Fair Poor Doesn't Apply to my visit

The caring and professional attitude of the staff?

Great Good Fair Poor Doesn't Apply to my visit

The cleanliness of the clinic?

Great Good Fair Poor Doesn't Apply to my visit

Who did you see on your last visit?Give the doctor/dentist's name

Would you recommend this clinic to family and friends?
Great Good
If no, why?
Was this your first visit to our clinic?

Yes No

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comments you may have