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Patient Survey
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* Indicates required question
I am the ...
*
Patient
Care Giver
Other
Other:
My most recent appointment was within the last...
*
Week
Month
6 Months
Year
My age is...
*
18-29
30-44
45-64
65-74
75+
I have been a patient of Dr. Warshauer's for...
*
1-6 months
6-12 months
1-3 years
3-5 years
5+ years
I am...
*
Male
Female
Prefer not to say
In the past year, I have been able to get an appointment as soon as I needed...
*
Always
Usually
Sometimes
Rarely
Never
In the past year, when I called with questions, my call was returned the same day...
*
Always
Usually
Sometimes
Rarely
Never
In the past year, I was seen by Dr. Warshauer within how many minutes of my appointment time...
*
0-15 minutes
15-30 minutes
30-45 minutes
45+ minutes
During my most recent visit, Dr. Warshauer explained all information patiently and answered all of my questions...
*
Strongly Agree
Agree
Neutral
Disagree
Strongly disagree
During my most recent visit, the staff was courteous and helpful...
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
During my most recent visit, I would rate my overall experience at Dr. Warshauer's office as a...
*
5 - Excellent
4 - Very High
3 - Neutral
2 - Needs Improvement
1 - Unacceptable
Please share any comments or suggestions below... thank you!
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