Physicians & Surgeons Patient Survey

Dear Patient:
This survey is to help us provide better service to all our patients.
We value your opinion and assure you your questionnaire will remain anonymous and your signature is not required.
Your participation is greatly appreciated, thank you.
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    Survey Questions

    Please answer each of the following questions from your personal experience at our office. Select the number which you consider to be the most appropriate answer. Key: 1=Poor 2=Satisfactory 3=Good 4=Excellent How would you rate the following:
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    OB SECTION

    If you are now pregnant, or had a baby delivered within the last year by a provider from this practice, please answer the follwing questions:
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    OB SECTION CONTINUED

    Please indicatie how satisfied you are with your provider's treatment of the following aspects of your care: Key: 1=Unsatisfied 2=Satisfied 3=Very Satisfied
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    GENERAL

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    Thank You!

    Thank you, your time in completing this survey is greately appreciated.