Desert Mountain OB/GYN, P.C.
14220 Northsight Blvd Ste 150 Scottsdale, AZ 85260/fax (480) 585-0828
Patient Satisfaction Survey
Date of appointment?
Which provider did you see today?
How did you hear about us?
Name of Physician
PLEASE RATE THE FOLLOWING (Circle the answer that best reflects your experience)
Experience of scheduling your appointment
First Impression of our office
Wait time in the lobby
Courtesy and respectfulness of the staff:
Adequate time with the provider
Questions answered thoroughly
Understood the oral/written instructions given
Respectful of your privacy
What was the primary reason for your visit?
Problem or illness
Likelihood of recommending our office to others
: This survey is intended to provide honest feedback and you contact information is not necessary. If you would like a manager to contact you to discuss your experience, please provide us with the following:
Write the characters in the image above
Medical Release Forms
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