Satisfaction Survey

Name:     Email:

Demographic Information

Please select how well you think we are doing in the following areas:

Ease of getting care

Ability to get in to be seen	Great	Good	Ok	Fair	Poor
Hours office is open	Great	Good	Ok	Fair	Poor
Convenience of office location	Great	Good	Ok	Fair	Poor
Prompt return on calls	Great	Good	Ok	Fair	Poor

Waiting

Time in waiting room	Great	Good	Ok	Fair	Poor
Time in exam room	Great	Good	Ok	Fair	Poor
Waiting for tests to be performed	Great	Good	Ok	Fair	Poor
Waiting for test results	Great	Good	Ok	Fair	Poor

Staff

Your Provider	Eric L. Lin MD
Listens to you	Great	Good	Ok	Fair	Poor
Takes enough time with you	Great	Good	Ok	Fair	Poor
Explains what you want to know	Great	Good	Ok	Fair	Poor
Gives you good advice and treatment	Great	Good	Ok	Fair	Poor

Nurses and Medical Assistants

Friendly and helpful to you	Great	Good	Ok	Fair	Poor
Answers your questions	Great	Good	Ok	Fair	Poor

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