Survey
Patient Survey
Please check the most appropriate response to each question based on your current visit. Your opinions of our clinic with respect to access and quality are important and sincerely appreciated.
Which physician or physician assistant did you see?

At which location were you seen?

Appointment Date:

Excellent Good Fair Unacceptable
Timeliness in response to message?
Ability to obtain a convenient appointment.
Convenience of medical office location.
Convenience of parking.
Length of time waiting in the office to see physician/physician assistant.
Length of time spent with physician/physician assistant.
Explanation of diagnosis and treatment by physician/physician assistant.
Technical skills of physician/physician assistant.
Personal manner of physician/physician assistant
Personal manner of office staff.
Cleanliness and comfort of medical office.
Overall rating of this office visit.
Would you recommend ILBNC?  Yes    No
do you have any suggestions or comments?
Name:
(Optonal)

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