Patient Satisfaction Survey

Your feedback would help us serve better in the future.

(This is just a sample survey and none of your data is stored through this survey)

How would you rate your appointment experience?

Not Satisfied

Satisfied

How long did you have to wait?

Not very long (10-20 minutes)

Longer than usual (20-30 minutes)

Very long (more than 30 minutes)

Was the staff polite?

Yes No

Do you believe there are enough appointment times available?

Yes, there are enough slots

No, there can be more slots

Did the payment options meet your expectations?

Yes, there are enough payment options

No, there can be more options

Enter a Sample Name

Enter Sample Appointment ID