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Patient Survey
We work hard to be the best that we can be. We would appreciate your feedback on the job we are doing. Please fill out the form below as completely as possible. Including your name and staff members' names help us to follow up on your comments.
Which location do you visit?
(Select one)
John Rolfe
Laburnum
Virginia Center Commons
Is your child currently being treated for any illness/injury?
Yes
No
Ease of getting through on the phone:
Excellent
Good
Fair
Poor
Very Poor
Ease of getting an appointment:
Excellent
Good
Fair
Poor
Very Poor
Length of time spent on hold:
Excellent
Good
Fair
Poor
Very Poor
Ability to get your phone call returned:
Excellent
Good
Fair
Poor
Very Poor
Friendliness and courteousness of the front office staff:
Excellent
Good
Fair
Poor
Very Poor
Length of time in the waiting room:
Excellent
Good
Fair
Poor
Very Poor
Caring of the nurses and medical assistants:
Excellent
Good
Fair
Poor
Very Poor
Length of time spent waiting in the exam room on the Doctor/NP:
Excellent
Good
Fair
Poor
Very Poor
Thoroughness of Doctor/Nurse Practitioner explanations and instructions:
Excellent
Good
Fair
Poor
Very Poor
Time spent with you in the exam room:
Excellent
Good
Fair
Poor
Very Poor
Helpfulness of the billing office:
Excellent
Good
Fair
Poor
Very Poor
Cleanliness of the facility:
Excellent
Good
Fair
Poor
Very Poor
Additional Comments:
Contact Name:
Contact Number:
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