Quality Care Survey

Please answer the questions below. Space is provided for additional information.

1. When you called for an appointment, were you satisfied with the response from the person who answered the phone?

   Yes
   No

2. When you arrived at the office, did you find the receptionist in our office:

   Friendly and Courteous?

   Yes
   No

   Helpful?

   Yes
   No

3. Were you pleased with the check-in process?

   Yes
   No

4. Were you seen in a timely manner?

   Yes
   No

Please answer the questions below on a scale from 1 to 5.
1 is the LOWEST and 5 is the HIGHEST response.

5. Rate your confidence in Dr. Gary Wiesman: Select 5 4 3 2 1
6. If you had an audiology appointment, rate your confidence in Scott Lightbody: Select 5 4 3 2 1
7. Did the medical staff spend an appropriate amount of time with you, answer your questions, and explain medical procedures and treatment to your satisfaction? Select 5 4 3 2 1
8. Likelihood of your recommending our practice to others: Select 5 4 3 2 1