Phone: (251) 344-5900
Fax: (251) 344-5172

 

Name (optional) 
Your Doctor 
Length of time as a patient of the practice? 


Excellent Good Fair Poor
Ability to reach the office by phone
Length of time you usually wait in the office
Waiting room comfort
Helpfullness/Friendliness of the front desk staff
Care/Concern on the part of the nursing staff
Amount of time you spend with your doctor
Quality of care provided by your doctor
Your experience (if applicable) with the business office
Ability to reach a nurse by phone
and/or promptness of call being retured
Your experience (if applicable) with
other physicians in this practice

Do you have any suggestions on how our practice might be improved?
Would you benefit by having earlier or later appointment times available?
If so, what would be your preference?


Do you have any needs you feel are not being met? If so, please explain.


Please let us know if one or more of our employees was especially helpful or if they were lacking in courtesy. We would like to share compliments or offer constructive advise to encourage good relationships with our patients.


Would your recommend our practice to a friend? Why or why not?