Services
    Physicians  

    Departments  
    Insurance

Mission

History

Certifications

Feedback

Home

Thomas Spann Clinic, P.A.
Survey Feedback Form

To all Thomas Spann patients and families of our patients, we would like to extend this opportunity to you by providing feedback to us in an effort to improve on our services. (As stated in our Mission Statement…).Your information will be kept confidential and you will only be contacted if you desire us to do so. Thank you for taking the time to fill this questionnaire out and allowing us the opportunity to serve you better.

Please enter your e-mail address:

Please enter your name:

1) What was the purpose of your visit to our office/clinic?

2) How was your experience in making your appointment?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

3) How satisfied were you with the way you were treated by your receptionists?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

4) How satisfied were you with the way you were treated by your nurse?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

5) Your Doctor?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

6) The amount of time you had to wait before being seen by the Doctor?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

7) The amount of time you had to wait before having your labs drawn?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

8) How satisfied were you with your phlebotomy experience?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

9) The amount of time you had to wait before having your X-rays performed?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

10) How satisfied were you with your Radiology experience?
Very Satisfied
Somewhat Satisfied
Undecided
Somewhat Dissatisfied
Very dissatisfied

11) My visit to the office/clinic was a pleasant experience.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree

11) Would you mind if we contacted you regarding any of the above issues?
Yes
No
Does Not Matter

Optional Information. Personal Information is kept confidential

Number where you may be contacted:

Best hours to contact you:
AM     PM