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General: 704.377.4009
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Patient Satisfaction Survey (Endoscopy Division)
Date of Visit
With whom did you have your visit?
First
Last
Which office did you visit?
Randolph Road
Ballantyne
Mooresville
When you called for an appointment, was your call handled in a timely and professional manner?
Yes
No
When you checked in for your appointment, where you treated in a professional manner?
Yes
No
When checking out at the business office, were you treated in a professional manner?
Yes
No
Were our fees / financial / insurance policies clearly explained to you?
Yes
No
During your visit did the doctor listen to and answer your questions clearly?
Yes
No
Do you feel the doctor spent enough time with you during your visit?
Yes
No
Would you refer our office to family or friends
Yes
No
How did you hear about our office?
Do you have any other suggestions or comments that may help us improve or expand the services we provide?