Patient Review Form Atlanta GA, Peachtree Dunwoody Oral & Facial Surgery, PC

Overall Rating:

First Name and Last Initial:

Email:

Which office did you visit

Which doctor did you see

Courtesy / friendliness shown to you by our staff over the phone:

Ease of scheduling your appointment with our office:

Were financial arrangements discussed in a courteous and clear manner at check-out?

Yes No

Were you greeted courteously and promptly at check-in?

Yes No

Waiting time

Was this your first visit?

Yes No

Procedure

Were you given a verbal explanation of the anticipated procedure by the doctor or the assistant?

Yes No

Did the surgical assistant introduce himself/Herself To You?

Yes No

Surgical assistants name:

Was the surgical assistant knowledgeable?

Yes No

Was the surgical assistant friendly/personable?

Yes No

Was the surgical assistant gentle?

Yes No

Did the doctor introduce himself/herself to you?

Yes No

Was the doctor knowledgeable?

Yes No

Was the doctor friendly/personable?

Yes No

Was the doctor gentle?

Yes No

Was there enough time with the doctor/surgical assistant to have your questions answered and concerns addressed?

Yes No

Was the examination room clean and neat?

Yes No

Will you return for additional care if needed?

Yes No

Would you recommend us to a friend?

Yes No

Overall staff rating:

Overall doctor rating:

Overall comments: *Required

Would you like to receive a call from our Practice Administrator regarding your experience?

Yes No

If so, please provide your phone number:

By clicking "Yes" you acknowledge you have read and agree to our . This grants us permission to publish your survey on our website and social media channels and send you a one time SMS text message. *Required

Yes No