Central Texas Foot Specialist Patient Satisfaction Survey
Patient Name: (optional)
Your answer
When was your appointment?
MM
/
DD
/
YYYY
Are you a new patient?
How did you hear about Central Texas Foot Specialist? *
Your answer
Length of time it took to get an appointment? *
Length of time spent in the waiting room to be seen? *
Length of time spent in the exam room waiting to be seen? *
Physical appearance and environment of the office? *
Extremely Dissatisfied
Extremely Satisfied
Friendliness and helpfulness of the front office staff *
Extremely Dissatisfied
Extremely Satisfied
Friendliness and helpfulness of medical assistants *
Extremely Dissatisfied
Extremely Satisfied
Satisfaction with the results of your care *
Extremely Dissatisfied
Extremely Satisfied
Overall satisfaction with Central Texas Foot Specialist *
Extremely Dissatisfied
Extremely Satisfied
Have you used our patient portal? *
Are there ways we can improve our service to you?
Your answer
Any suggestions or other comments?
Your answer
May we publish your survey to the web? *
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