Nothing is more important to us than your satisfaction. Our goal is to provide
comfort, convenience, and satisfaction as well as the very best medical care
to all our patients. Your comment will help us evaluate our operations to
ensure we are truly responsive to your needs. All personally identifiable
information will be kept strictly confidential.
Comment Card
Date of Visit (month/date/year)
Doctor/Nurse Practitioner who saw
you?
Which office did you visit?
How long have you been a patient at
this practice?
How satisfied are you with the following?
Visit Overall
Appointment available within a
reasonable amount of time
Appearance of office
Wait time in office
Amount of time with Doctor/ARNP
Doctor/ARNP understanding the
special needs and condition of women
Front office staff friendly and courteous
Billing staff answered all your
questions
Comments: