Tel. (731) 661-9825 1-888-661-9825 Fax. (731) 668-6757
P A T I E N T S U R V E Y
Date of Service:
Courtesy of the schedulers
Length of time until your appointment
Cleanliness of the reception area
Length of your wait in the reception area
Courtesy of the Staff who takes you to the Exam Room
Courtesy of the Nursing Staff
Courtesy of the X-ray Staff
Courtesy of the Casting/Bracing Staff
Courtesy of your physician
Ability to have all of your questions answered by the physician
Treatment you received from your physician
Courtesy of the check out staff
Ease of scheduling your next appt. and/or test.
Overall satisfaction of today's visit
If one thing about today’s visit could be improved, what would it be?
Please select... Make it easier to get appointment Waiting Time Friendlier Physicians Friendlier Staff Improved Parking Telephone Service Understanding my Medical Results Not A Thing
Which physician did you see? Please select Lowell F. Stonecipher, M.D. Robert Michael Cobb, M.D. L. David Johnson, M.D. Kelly D. Pucek, M.D. Harold M. Antwine, III, M.D. John E. Everett, M.D. David A. Pearce, M.D. Jason T. Hutchison, M.D. Adam M. Smith, M.D.
Who referred you to us?
Would you refer us to others? Yes No
Other Comments or Suggestions for Improvement:
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