Our Services

Survey

Confidential Patient Satisfaction Survey

We want your opinion ~ We value your feedback ~ We want to meet and exceed your expectations
Please take a few minutes to let us know your experience at the Heart Center. We truly appreciate your feedback.

Office you visited:
Date of your visit (Click to Select):
Sex:
Age:
Are you a new patient to our practice?
Your Zip Code:
Your Health Insurance:


Access to Care – Your Experience
Reaching the office staff by phone
Length of time until obtaining a scheduled appointment with doctor
Overall helpfulness of the staff
Office Visit – Your Experience
Length of time in the waiting room before taken by staff to the exam/consultation room.
Length of time spent in the exam/consultation room waiting for the doctor
The doctor’s interest in and attention to my problem
The thoroughness of the doctor’s examination
The doctor’s explanation of my problem(s) and the need for additional tests and treatment
Overall satisfaction with my visit

Would you recommend this doctor’s office to family, friends and coworkers? Yes No

Please feel free to add any additional comments: