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Patient Satisfaction Survey

Patient Satisfaction Surveyctidev2019-11-26T15:54:34+00:00

Patient Satisfaction Survey

We value you as our patient and invite you to take a few minutes to fill out this survey.

Step 1 of 3

33%

Please select one*
- Male
- Female
How old are you?*
- 20-29
- 30-39
- 40-49
- 50-59
- 60-69
- 70-79
- 80-89
- 90+
Please select your age range
Zip Code:*
ZIP / Postal Code
Are you a:*
- A New Patient
- An Established Patient?

If you are an established patient, how many years have you been coming to our practice?*
- 0-5
- 5-10 years
- 10-15 years
- greater than 15 years
How did you hear about us?*
- Friend/Relative
- Doctor / Health Professional
- Internet
Name or Website*
Name of the person you heard about us from or website:
Who is your primary care provider?*
How easy was it to make an appointment?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
How helpful and courteous was the staff that made your appointment?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
How easy was the check-in process?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
How helpful and courteous was the staff at check-in and check-out?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
How helpful and courteous were the medical assistants that helped your doctor in your clinical case?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
Did anyone hurt you during any procedure done at MetroDerm?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
Did you feel that the facility and staff were clean and used appropriate hygiene measures during your visit?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Did you feel that the facility and staff were clean and used appropriate hygiene measures during your visit?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments

Which physician or Physician's Assistant (PA) did you see today?*
How would you rate your visit with the physician or PA today?*
- 1
- 2
- 3
- 4
- 5
1 being least helpful, 5 being most helpful
Comments
Do you use a computer?*
- Yes
- No
Do you read reviews about doctors on the internet?*
- Yes
- No
Do you use Social Media?*
- Facebook
- Twitter
- Instagram
- All of them
Do you use / watch YouTube?*
- Yes
- No
Are you interested in cosmetic procedures?*
- Yes
- No
What type / types?
Would you like to receive info about new medical and/or cosmetic procedures done here at MetroDerm?*
- Yes
- No
Would you be interested in attending an Open House about new procedures or techniques?*
- Yes
- No
Overall, how would you rate your experience during your visit? (1 = poor, 5 = excellent)*
- 1
- 2
- 3
- 4
- 5
Suggestions for improvement / comments:

Johnson Ferry

875 Johnson Ferry Rd., NE
Suite 180, Suite 300
Atlanta, GA 30342

Phone: 404-257-9933
Fax: 404-257-9931

Hiram

148 Bill Carruth Parkway
Suite 280
Hiram, Georgia 30141

Phone: 678-363-3343
Fax: 678-363-3380

Lilburn

4150 Five Forks Trickum Rd.
Suite 3
Lilburn, Georgia 30047

Phone: 770-921-4740
Fax: 770-921-1993

Alpharetta

3155 North Point Parkway
Building E, Suite 100
Alpharetta, GA 30005

Office: 770-475-6222
Fax: 770-667-9522

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