Riverdale Family Medicine, P.A.
We would like to take this opportunity to thank you for allowing us to care for your medical needs. We take pride in our services and would like to know how you think we are doing. Please take a few minutes to complete this questionnaire.
1. Ease of scheduling an urgent appointment.
Poor
Excellent
Clear selection
2. Friendliness and courtesy of our front office staff.
Poor
Excellent
Clear selection
3. Friendliness and courtesy of our back office staff.
Poor
Excellent
Clear selection
4. Wait time in lobby.
Poor
Excellent
Clear selection
5. Wait time in exam room.
Poor
Excellent
Clear selection
6. Trust in provider to make decisions and recommendations that are in the best interest of the patient.
Poor
Excellent
Clear selection
7. How the provider listens and answers questions.
Poor
Excellent
Clear selection
8. Scheduling referrals in a timely manner.
Poor
Excellent
Clear selection
• We are happy to hear any additional comments that you would like to share with us.
Your name and Email address - Optional
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy