1. My Appointment was made within a reasonable amount of time:
Strongly Agree Agree Neutral Disagree Strongly Disagree
2. The receptionist/office staff were helpful and courteous.
Strongly Agree Agree Neutral Disagree Strongly Disagree
3. My appointment started on time.
Strongly Agree Agree Neutral Disagree Strongly Disagree
4. The nurse/assistance was helpful and courteous.
Strongly Agree Agree Neutral Disagree Strongly Disagree
5. The physician or nurse practitioner treated me with respect and concern.
Strongly Agree Agree Neutral Disagree Strongly Disagree
6. The physician or nurse practitioner adequately addressed my questions and gave understandable answers.
Strongly Agree Agree Neutral Disagree Strongly Disagree
7. I am satisfied with the thoroughness and completeness of my medical treatment.
Strongly Agree Agree Neutral Disagree Strongly Disagree
8. I was given appropriate instruction regarding future appointments or follow up care.
Strongly Agree Agree Neutral Disagree Strongly Disagree
9. Overall, I was pleased with my visit.
Strongly Agree Agree Neutral Disagree Strongly Disagree
10. Why did you choose this clinic?
Recommended/Reputation Advertisement Nearest Location Other
Physician/Nurse Practitioner Name:
Patient Satisfaction Survey
Location
1890 Alabama Highway 157, Suite 300
Cullman, AL 35058
Phone: 256-737-8000
Fax: 256-737-8058
Office Hours