Please take a moment to complete our patient survey.
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| Name: (optional) |
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| Email: (optional) |
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Would you like us to contact you.
Yes
No
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| Date of visit (if applicable): |
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| Office Location: |
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South Orlando- 44 Lake Beauty Drive; Suite 300, Orlando, FL 32806 |
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Kissimmee- 809 East Oak Street, Heritage Square, Kissimmee, FL 34744 |
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Rockledge-1978 Rockledge Blvd., Suite 105, Rockledge, FL 32955 |
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Daytona- 529 Health Blvd., Daytona Beach, FL 32114 |
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Deland- 305 East New York Ave., Deland, FL 32724 |
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New Smyrna-415 North Causeway, New Smyrna Beach, FL 32169 |
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| Promptness in the scheduling of your appointment |
Excellent
Very Good
Satisfactory
Below Average
Poor
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| Friendliness of Personnel |
Excellent
Very Good
Satisfactory
Below Average
Poor
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| Where did you spend the most time waiting in our office |
Waiting Room
Patient Room
Testing
Explanation of test results |
| Convenience of office locations |
Excellent
Very Good
Satisfactory
Below Average
Poor |
| Cleanliness of our office locations |
Excellent
Very Good
Satisfactory
Below Average
Poor |
| Professional manner of our staff |
Excellent
Very Good
Satisfactory
Below Average
Poor |
| Physicians explanation and treatment of illness |
Excellent
Very Good
Satisfactory
Below Average
Poor |
| What did you like BEST about our practice? |
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| What did you like LEAST about our practice? |
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| What suggestions do you have that might help us serve you better? |
(*maximum 60 characters)
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