Patient Survey, Associates In Oral & Facial Surgery, Benjamin E. First, DMD, PA

	Associates In Oral & Facial Surgery Benjamin E. First, DMD, PA

	Palm Harbor Office Stonebridge Professional Park 4156 Woodlands Parkway, Suite B voice 727.786.9600	New Port Richey Office 6906 Madison Street, Suite 2 voice 727.849.8100

patient survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

All items must be completed.

age **

sex* male female

race / ethnicity* asian pacific islander black / african american american indian / alaskan native white (not hispanic or latino) hispanic or latino (all races) unknown

please select how well you think we're doing in the following areas:
ease of getting care
ability to get in to be seen	great good ok fair poor *
hours office is open	great good ok fair poor *
convenience of office location	great good ok fair poor *
prompt return of calls	great good ok fair poor *
waiting
time in waiting room	great good ok fair poor *
time in exam room	great good ok fair poor *
staff, provider
listens to you	great good ok fair poor *
takes enough time with you	great good ok fair poor *
explains what you want to know	great good ok fair poor *
gives you good advice and treatment	great good ok fair poor *
staff, surgical assistants
are friendly and helpful	great good ok fair poor *
answer your questions	great good ok fair poor *
front desk
is friendly and helpful to you	great good ok fair poor *
answers your questions	great good ok fair poor *
payment
explanation of charges	great good ok fair poor *
payment options	great good ok fair poor *
facility
neat and clean building	great good ok fair poor *
ease of finding where to go	great good ok fair poor *
comfort and safety while waiting	great good ok fair poor *
privacy	great good ok fair poor *
confidentiality
keeping my personal information private	great good ok fair poor *

likelihood of referring friends and relatives	great good ok fair poor *

what do you like best about our office?
*too many characters
what do you like least about our office?
*too many characters
suggestions for improvement?
*too many characters