Pulmonary and Sleep Associates of South Jersey
Patient Survey
To help us improve our service to you, please submit a survey below.
Your name: *
Your answer
How long was the wait in the office before you were seen (after appointment time)
Providers and Staff listened to your concerns
Strongly Disagree
Strongly Agree
The provider reviewed and talked about all medications you are taking (prescription, over the counter, and herbal)
Strongly Disagree
Strongly Agree
Name of Provider:
Your answer
Rating of Provider:
Poor
Excellent
Rating of Office Staff:
Poor
Excellent
How would you rate this practice?
Poor
Excellent
Would you recommend this practice?
Never
Highly Recommend
Comments:
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