Kearney Clinic, P.C.

SATISFACTION SURVEY
At Kearney Clinic, we are continually striving to improve care and services for our patients. We value your comments, suggestions and opinions.

Please take a few moments to answer the following questions regarding the services we provided.

Your Name:	First
	Last

How did you hear about Kearney Clinic?


Newspaper	Physician
Radio	Other Provider
TV	Phone Book
Friend	Already Established Patient

Appointment With:

Appointment

Time

Walk-In

Time

Were you satisfied with your treatment? 1=Very Little - - - - 5=Very Much

At the front desk?			By the physician?
By the nurse?			By other office staff?

After arriving at our office, did you have to wait to see the physician?

If yes, how many minutes did you have to wait?

There are times when we need to stitch up cuts, set fractures, or treat serious illnesses on an unplanned basis. Although we schedule time for this we sometimes fall behind schedule. Please alert us if your waiting time is more than 30 minutes.

Was your treatment helpful?

Would you come back to Kearney Clinic?

Would you recommend the Doctor you saw today to others?

Comments or suggestions:




	Online Bill Pay

	Appointments

	New Patient Pre-Registration

	Consent Form

	Notice of Privacy

	Fees and Payment

	Insurance

	Satisfaction Survey

	Web Nursery


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