Customer Survey

	*We Value Your Opinion!*
	Date of your consult:	Month
		Day
		Year
	What was it that made you come to our office?
	How was our telephone etiquette?
	Were you greeted in a friendly, timely, and professional manner in our office?	Yes No
	Who was your consultant?	Linda Doros
		Pam Cadle
		Other
	Did your consultant conduct themselves in a professional manner?	Yes No No Opinion
	Did they spend enough time with you?	Yes No No Opinion
	Did they answer all your questions?	Yes No No Opinion
	Did the consultant seem knowledgeable about the procedures you were inquiring about?	Yes No No Opinion
	Did Dr. Martin spend enough time with you?	Yes No No Opinion
	If not, what time frame would be more appropriate and what needed to be covered that was not?
	Did you obtain enough information to make an informed decision?	Yes No No Opinion
	Did you obtain enough information regarding pre-operative instructions and post-operative care that you felt educated as to what to expect? (given at pre-operative visit)	Yes No No Opinion
	If you have looked at our web site, can you tell me what you think of the presented information and are there any ways to improve it?
	If you have had a consult with another physician, how would you compare that consult to ours? If something in particular was better than ours, could you please specify?
	If you have chosen to go to another plastic surgeon, could you tell us why?
	If you have chosen to stay with Dr. Martin, could you tell us why?
	How was your surgical experience?
	Did your office adequately follow you during the post-operative period?	Yes No No Opinion
	Regarding our receptionist - Angie Boileau, did you find her professional and helpful?	Yes No No Opinion
	Regarding our Physician Assistant, Robert Wright PA-C, Did you find him professional and helpful?	Yes No No Opinion
	Regarding our office manager, Sylvia Bennett, did you find her professional and helpful?	Yes No No Opinion
	Regarding our surgical nurse, Dixie Morrison, did you find her professional and helpful?	Yes No No Opinion
	Regarding our medical assistant, Linda Doros, did you find her professional and helpful?	Yes No No Opinion
	How could we have made your experience better?