Patient Satisfaction Survey Basic Information Name Location * Waco Date of Appointment * Which Doctor Treated You? * Dr. SappingtonDr. ShahDr. Avery Are you a New Patient or Established Patient? * New PatientEstablished Patient Staff Performance How close to your scheduled time did your appointment start? 0-15 minutes16-30 minutes31-45 minutes46+ minutes How would you rate the performance and friendliness of the receptionist? star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars How would you rate the performance and friendliness of the medical assistant? star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars Physician Performance How would you rate the attitude of the physician? star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars How well did the physician explain your condition? star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars Overall Experience How would you rate the cleanliness of our office? star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars Would you recommend our practice to a family member or friend? Yes No What could we have done better? What else would you like to tell us about? reCAPTCHA
