Patient Center

Please use the following scale to answer the questions below:
1 = Very poor | 2 = Poor | 3 = Average | 4 = Very good | 5 = Excellent

1. How would you rate our switchboard and telephone service?
   1 2 3 4 5

2. Did you find it easy to make an appointment?
   1 2 3 4 5

3. Was our staff helpful?
   1 2 3 4 5

4. Did the doctor clearly explain the problem and the treatment he prescribed?
   1 2 3 4 5

5. Did you feel that the doctor was truly concerned for your well-being?
   1 2 3 4 5

6. Did your physician spend adequate time with you during your visit?
   1 2 3 4 5

7. Did you feel that your check out and bill payment was courteous and efficient?
   1 2 3 4 5

8. Was the staff helpful in helping you with your insurance coverage?
   1 2 3 4 5

9. Did our medical assistants make you comfortable?
   1 2 3 4 5

10. Do you feel you received the highest quality of care from your phsyician?
    1 2 3 4 5

11. Please rate your overall experience and quality of care provided by FMI.
    1 2 3 4 5

12. How was your wait time?
    1 2 3 4 5

How many miles did you travel to reach our office?

Would you recommend FMI to your family and friends? Yes No

If you answered no to the previous question, please explain:

Do you have any comments or recommendations on how we might serve you better?

Would you like to be added to our Mailing List? Yes No