HOW WAS YOUR VISIT TODAY?

Thank you for your visit to Dent Neurologic Institute.
We need your input to enable us to provide the best
quality of care to our patients. Please take a few minutes
to fill out this questionnaire.

Please evaluate each area. Thank your for your cooperation!

 

    
REASON FOR APPOINTMENT:

 
         
  Yes No    
Did the doctor have the appropriate
information available at the time of your appointment?		    
         
OVERALL IMPRESSION:        
Were you satisfied with your visit?    
Would you recommend Dent to family
and friends?		    
         
APPOINTMENT SCHEDULING: Excellent Good Fair Poor
Was your appointment scheduled in a
reasonable amount of time?
 

Courteous Telephone Staff
         
REGISTRATION:        
Waiting time for registration
Registration Process
Reception Area Staff
Waiting area
Assistance with question/forms
         
CLINIC OPERATIONS:        
Courteous & attentive provider
Exam performed professionally
Exam room clean/comfortable
Waiting time kept minimum
Clinical Support Staff
Secretarial Staff
Return of calls left on voice mail
         
OTHER COMMENTS:

         
Provider/Physician Name: