Patient Satisfaction Survey

Your feedback helps us care for you better. Please tell us about your recent visit — it takes just a few minutes and is reviewed by our care team.

This survey is confidential and will not affect your care in any way. You may skip any question.

Your visit

A little context about the appointment you're rating.

Date of visit

June 11, 2026

Provider seen — optional

Dr. Okafor

Reason for your visit

Annual physical

Rate your experience

1 = poor · 5 = excellent

Poor234Excellent

Ease of scheduling your appointment

12345

Wait time before being seen

12345

Courtesy of front-desk & nursing staff

12345

Your provider listened & explained clearly

12345

Cleanliness & comfort of the facility

12345

Comments

What went well during your visit?

The nurse was kind and the doctor took time to answer all my questions without rushing.

What could we improve?

The wait was about 25 minutes past my appointment time — a heads-up would have helped.

Would you recommend our practice to family or friends?

Definitely Probably Unsure No

Your answer: Definitely

Thank you. Your responses go directly to our care team and help us improve the experience for every patient.

Cedar Hollow Family Medicine · 88 Orchard Way · Confidential patient feedback