We appreciate your business and want you to be satisfied with every aspect of your treatment. Realizing that we do so much with our mouth (speaking, smiling, eating, etc.), we recognize that our success in serving you can be a significant factor in your overall satisfaction in life.

Our highest priority, every day, is to provide our patients with consistently superior service. If we have failed to serve you properly in any way or simply have not measured up to your expectations, we would like to know.

This questionnaire is intended to help us evaluate our performance, especially in cases where we might have fallen short for some reason. Please take a moment at your convenience to rate our effort.

Thank you for giving us the opportunity to serve you.

 

Initial Visit Excellent Good Fair Needs Work
Introduction to Office
Interview
Doctor's Exam
Financial Discussions
Questions Answered


Reception Areas Excellent Good Fair Needs Work
Telephone Calls
Staff Hospitality
Areas Neat and Clean
Insurance Handling
Special Requests


Treatment Areas Excellent Good Fair Needs Work
Care and Empathy
Courtesy and Response
Helpfulness
Competence/Knowledge
Cleanliness


General Comments Excellent Good Fair Needs Work
Professionalism
Personal Comforts
Office Atmosphere


  Emphatic Yes Yes Okay No Never
Would you recommend our service to others?



We are committed to excellence. We can only improve if we know where we need improvement. Please tell us how we can achieve a more "excellent" status.


 
       
AAO
Long Pond Medical Building • 110 Long Pond Rd., #122 • Plymouth, MA 02360 • Phone: (508) 747-4667
93 Route 6A, Suite B-1 • P.O. Box 1039 • Sandwich, MA 02563 • Phone: (774) 413-5645

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