Patient Satisfaction Survey 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*MaleFemaleHow old are you?*20-2930-3940-4950-5960-6970-7980-8990+Please select your age range Zip Code:* ZIP / Postal Code Are you a:*A New PatientAn Established Patient? If you are an established patient, how many years have you been coming to our practice?*0-55-10 years10-15 yearsgreater than 15 yearsHow did you hear about us?*Friend/RelativeDoctor / Health ProfessionalInternetName 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?*123451 being least helpful, 5 being most helpfulCommentsHow helpful and courteous was the staff that made your appointment?*123451 being least helpful, 5 being most helpfulCommentsHow easy was the check-in process?*123451 being least helpful, 5 being most helpfulCommentsHow helpful and courteous was the staff at check-in and check-out?*123451 being least helpful, 5 being most helpfulCommentsHow helpful and courteous were the medical assistants that helped your doctor in your clinical case?*123451 being least helpful, 5 being most helpfulCommentsDid anyone hurt you during any procedure done at MetroDerm?*123451 being least helpful, 5 being most helpfulCommentsDid you feel that the facility and staff were clean and used appropriate hygiene measures during your visit?*123451 being least helpful, 5 being most helpfulDid you feel that the facility and staff were clean and used appropriate hygiene measures during your visit?*123451 being least helpful, 5 being most helpfulComments Which physician or Physician's Assistant (PA) did you see today?*How would you rate your visit with the physician or PA today?*123451 being least helpful, 5 being most helpfulCommentsDo you use a computer?*YesNoDo you read reviews about doctors on the internet?*YesNoDo you use Social Media?* Facebook Twitter Instagram All of them Do you use / watch YouTube?*YesNoAre you interested in cosmetic procedures?*YesNoWhat type / types?Would you like to receive info about new medical and/or cosmetic procedures done here at MetroDerm?*YesNoWould you be interested in attending an Open House about new procedures or techniques?*YesNoOverall, how would you rate your experience during your visit? (1 = poor, 5 = excellent)*12345Suggestions for improvement / comments:CAPTCHA
