Patient Survey

Optional Personal Information

If you would like feedback from our staff, please provide the following information.

Name

First Last

Phone

Email

May we use your comments as a testimoninal on our website or other materials?

Your first name and town will be public.

Date of Appointment

Time of Appointment

:

Which Clinic Did You Visit?

Appointment or Sick Call

Which Physician/APN Did You See

Please rank from 1-5 (5 being the best)

The office staff was helpful and courteous.

I was able to schedule an appointment in a timely manner.

The waiting areas were welcoming, clean, and comfortable

My appointment started and ended on time.

My doctor or APN was/were helpful and courteous

If applicable, How would you rate the service and professionalism of the nursing staff?

I would recommend Pocahontas Medical Clinic to my friends and family.

How long did you have to wait to be seen by a doctor/nurse?

What did you like most about your visit to our office?

What did you like least about your visit to our office?

What can we do to make future visits better for you?

We welcome your questions or comments.