Satisfaction Survey

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SATISFACTION SURVEY

Thank you very much for choosing Premier Gastroenterology!

We would like to have feedback from our patients, both positive and negative if necessary. Only if we hear from you will we know what we are doing right and what we need to improve.

Please complete the following short survey at your convenience. There is also a section for comments, so please feel free to elaborate. This survey is confidential, is sent directly to management, and will in no way impact your care in our office.

We appreciate your input!

Sincerely,

The Physicians of Premier Gastroenterology

Name*
First Last
Email*
Phone*
What was your favorite thing about our office?*
How could we have made your patient experience better?*
How would you rate your experience?*
- Positive
- Negative
How long have you been a patient at our office?*
Choose your Provider/Doctor*
Would you like me to share this with your doctor?*
- Yes
- No
Would you like me to contact you about your experience?*
- Yes
- No
Please provide any additional comments here: