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

Provider seen — optional

Reason for your visit

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?

What could we improve?

Would you recommend our practice to family or friends?

Definitely Probably Unsure No

Your answer:

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