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Patient Satisfaction Survey
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Were you happy with the amount of time it took to get an appointment with your physician?
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Not Happy
Somewhat Uunhappy
Somewhat Happy
Happy
Were you happy with the amount of time your physician spent during your visit?
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Not Happy
Somewhat Unhappy
Somewhat Happy
Happy
Did your physician answer all your questions to your satisfaction?
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Not Satisfied
Somewhat Unsatisfied
Somewhat Satisfied
Satisfied
Did the office staff treat you with courtesy and respect during your visit?
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No Respect
Somewhat Disrespectful
Somewhat Respectful
Respect
Please rate your overall satisfaction with this visit:
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Poor
Fair
Good
Excellent
Additional Comments
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