Premier Patient Satisfaction Survey
Please take a moment to complete this survey. We would like to know how successful your visit was today, and if there is anything we could do differently next time to improve our service.
I prefer to respond anonymously:
Name
Company
Email
Day of your appointment?





Time of your appointment?
Procedure:








What doctor ordered this exam?
Why did you choose Premier?




If you selected other, please explain:
How was the convenience of our office location?
           
Convenience of parking?
           
Cleanliness of facility
           
Length of time waiting for procedure?
           
Registration process?
           
Staff friendliness, professionalism, courtesy, and respect?
           
Overall experience?
           
What would have made your experience at Premier more pleasant?