Patient Name
Date of last visit:
1. Promtness in the scheduling of your appointment: Excellent Very Good Satisfactory Below Average Poor
2. Friendliness of Personnel: Excellent Very Good Satisfactory Below Average Poor
3. Where did you spend the most time waiting in our office: Waiting Room Patient Room Echo Lab Explanation of test results
4. Convienience of office locations: Excellent Very Good Satisfactory Below Average Poor
5. Cleanliness of our office locations: Excellent Very Good Satisfactory Below Average Poor
6. Proffesional manner of our staff: Excellent Very Good Satisfactory Below Average Poor
7. Physicians explanation of illness and it’s treatment: Excellent Very Good Satisfactory Below Average Poor
What did you like BEST about our office?
What did you like LEAST about our office?
What suggestions do you have that might help us serve you better?
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407.856.7226 | 407.856.7229 FAX | 2501 North Orange Avenue, #310 Orlando, FL 32804
