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Patient Survey
Overall how would you rate your visit?
Excellent
Above Average
Average
Below Average
Poor
How would you rate the length of time it took to get an appointment in our practice?
Excellent
Above Average
Average
Below Average
Poor
Please rate the friendliness of the reception staff.
Excellent
Above Average
Average
Below Average
Poor
How long did you wait in our reception area before seeing a nurse?
0-10 Minutes
10-15 Minutes
15-20 Minutes
20-30 Minutes
Greater than 30 Minutes
Please rate the friendliness and professionalism of the nursing staff.
Excellent
Above Average
Average
Below Average
Poor
How long did you wait in our reception area before seeing a physician?
0-10 Minutes
10-15 Minutes
15-20 Minutes
20-30 Minutes
Greater than 30 Minutes
Please rate the friendliness and professionalism of the physician(s).
Excellent
Above Average
Average
Below Average
Poor
Would you recommend our practice to your friends and family?
Yes, without a doubt
Unsure
No
Is there anyone in our practice that you would like to give a special word of thanks?
Are there any suggestions you would make to help us improve our practice?
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West Georgia Obstetrics & Gynecology, P.C. | 109 Professional Place | Carrollton, Georgia 30117 | USA | Voice 770-834-0170 | Fax 770-214-1546
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