Patient Care Questionnaire



Name: (Optional)

Appointment Date:

Were you signed in quickly and efficiently at the front desk?

Was the Secretary courteous and friendly?

Was the Technologist kind and courteous?

Were you taken in for your examination in a timely manner?

Were all of your concerns and questions addressed/answered to your satisfaction?

Do you have any suggestions that would improve the quality of our patient care?


Please feel free to ask for the Office Manager or Chief Technologist to address concerns you may have.


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