Patient Satisfaction Survey

Most Recent Visit
Date of Visit:  
     
Name of Attending Staff:  
     
Were you seen promptly?

 
Was your doctor or provider helpful?

 
Was your doctor or provider friendly?

 
Was your doctor or provider professional?

 
Was your doctor or provider properly attired?

 
Were all staff members helpful and polite?

 
Your Overall Experience
 
Your Normal Doctor or Provider:  
     
How would rate the quality of care you have received from EIM?