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Our goal is to provide you with the best possible medical care.  Please take a moment to share your feedback with us.  Your comments will be kept strictly confidential.  Thank you for taking the time to help us.

1.        Was this your first visit?                               ___  Yes               ___  No

 

2.       Why did you decide to seek medical treatment at our office?  Check all that apply.

___  Found you on line

___  It’s near my office or home

___  Referred by another physician

___  Referred by another patient

___  Saw an advertisement

___  Telephone listing

___  Other

For questions 3-10, please give us a grade in each of the following areas:

3.       I was able to make an appointment promptly at a convenient time.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

4.       The staff that helped me make my appointment was courteous.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

5.       When I arrived, the reception desk was helpful and courteous.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

6.       The exam room was clean and comfortable.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

7.       Dr. Arabshahi was interested in my problem.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

8.       Dr. Arabshahi explained my treatment and illness.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

9.       I was satisfied with the medical treatment I received.

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

10.   My overall visit to Advanced Foot Clinic:

__  Excellent      __  Above Average         __  Average        __  Needs Improvement                     __  Poor      __  N/A

 

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