Patient Satisfaction Survey

Patient Satisfaction Survey

Please help us improve the quality of our patient care by completing this brief confidential survey. Only AMS staff will review the results of your feedback. Upon completion, please drop off at the receptionist’s desk. We value you as a patient and appreciate your participation. Thank you!


1. Thinking about the way the doctor or practitioner listed above talks to you, how well does he/she:


2. Thinking about the quality of care you receive from the doctor or practitioner listed above, please rate:


3. Thinking about the doctor's or practitioner's availability, please rate:


4. Regarding the quality of customer service during your visits to the practice listed above, how would you rate each of the following?


5. Overall, how would you rate your satisfaction with the doctor listed above?


6. Would you recommend this doctor/practitioner to family or friends?


7. How did you hear about our office? (Circle one)


Please place this confidential survey in the locked box before you leave today. Thank you for your time! Your input will help us better serve you.

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