Name *
E-mail Address *
Which office location did you most recently visit? *
Albertville
Guntersville
Which physician did you see? *
Dr. Groves
Dr. Britt
What kind of visit was this? *
It was my first visit
I am existing patient, but I came in with a new problem
It was a visit to discuss or schedule surgery
It was a post-op appointment
It was a follow up appoinment (more than 30 days after surgery)
Where you satisfied with the timeliness in which you were made an appointment from the time you requested one? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
How were you satisfied with the front office staff? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
Were you pleased with your wait time once you arrived in our office? *
5 - very pleased
4 - pleased
3 - neutral
2 - unpleased
1 - very unpleased
How were you satisfied with the nursing staff? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
Were you satisfied with the amount of time the doctor spent with you? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
Were you satisfied that the doctor's examination/visit and plan of action? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
How were you satisfied with the billing/insurance staff? *
5 - very satisfied
4 - satisfied
3 - neutral
2 - unsatisfied
1 - very unsatisfied
Overall, how would you rate your experience with our office? *
5 - fantastic
4 - good
3 - neutral
2 - bad
1 - horrible
Do you have any comments about your visit or suggestions to help improve our practice?
