Patient Survey :: Mountain Podiatry

Name

First Last

Condition being treated by doctor:*

1. Were you called to remind you of the appointment?*

2. Were you given an appointment on the day you requested?*

3. Do you feel you were brought back in a timely manner?*

4. Do you feel all your questions were answered by the doctor?*

5. Do you feel the doctor spent an adequate amount of time with you?*

6. If you spoke with members of the staff on the phone, were they friendly and identify themselves when answering the phone?*

7. Would you recommend our practice to a friend or family?*

Please either expand on any points above, other concerns, or if you have any compliments, please write below.

Phone

This field is for validation purposes and should be left unchanged.