[gtranslate]

    Name (optional)

    Phone (optional)

    Email (optional)

    Which one of our clinics did you visit? (Please select from the drop-down.)

    Were you greeted by the staff upon arrival?
    YesNo

    Did the staff answer any questions you may have had?
    YesNo

    Did you meet with the Office Manager?
    YesNo

    Did the doctor take the time to answer any questions you may have had?
    YesNo

    Did we explain the services that you needed in a way that was easy to understand?
    YesNo

    Did the office personnel treat you in a professional and kind manner?
    YesNo

    Was the reception area neat and clean?
    YesNo

    Were you satisfied with the quality of care provided to you?
    YesNo