Quality Care Survey

Thank you for choosing Parks Dermatology Center. Our goal is to provide outstanding quality patient service. Your feedback is very important to us, as we will use your opinion to improve the quality of our care and services.

Patient Name
(Optional)
E-Mail Address *
(Required for drawing entry)
Date of Birth
MM/DD/YYYY (Optional)
Patient Name
(Optional)
Location *
Survey Questions
Poor
1
Fair
2
Good
3
Very Good
4
Excellent
5
1) The ease of making an appointment by phone:
2) The professionalism and courtesy of our staff:
3) The quality of medical care provided:
4) Medical concerns were explained in a way you could understand:
5) The amount of time you spent waiting was reasonable given your dermatologic condition:
6) Your overall satisfaction with our practice:
7) Would you recommend us to a friend?
Yes
No
Additional Comments:
Thank you... We greatly value your opinion.

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