To help us serve you better, we would appreciate you fill out this report card.

Did we greet you promptly and cheerfully?	Low (1) (2) (3) (4) High
Was our office neat and clean?	Low (1) (2) (3) (4) High
How is our magazine selection?	Low (1) (2) (3) (4) High
How do you like our office decor?	Low (1) (2) (3) (4) High
Was there adequate parking?	Low (1) (2) (3) (4) High
Were you seen on time?	Low (1) (2) (3) (4) High
If we were late, was it explained?	Low (1) (2) (3) (4) High
Have your phone calls or lab results been returned promptly?	Low (1) (2) (3) (4) High
Do you like being called by your first name?	Low (1) (2) (3) (4) High
Were you comfortable during your treatment?	Low (1) (2) (3) (4) High
Was our staff courteous?	Low (1) (2) (3) (4) High
Have we answered your questions clearly?	Low (1) (2) (3) (4) High
Did you understand why particular care was recommended?	Low (1) (2) (3) (4) High
How well are we responding to your needs?	Low (1) (2) (3) (4) High
Would you recommend us to your family and friends?	Low (1) (2) (3) (4) High
As a patient of Dr. , I would like to tell him/her:
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