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office fax: 334-262-0390
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Patient Satisfaction Survey
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Indicates required field
Date of your visit:
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Who is your physician?
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Dr. Glenn Yates
Dr. James McLaughlin
Dr. Raghu Mukkamala
Dr. Rakesh Patel
Dr. Ana Tejero
Dr. Peter Krothapalli
When you called the office, was your call handled promptly and courteously?
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Yes
No
When you arrived, were you greeted in a friendly manner?
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Yes
No
How long was your wait time to see the physician?
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Less than 10 minutes
10-20 minutes
20-30 minutes
30-45 minutes
More than 45 minutes
From the time of your scheduled appointment until you saw the physician.
Did your nurse seem caring and interested in your care?
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Yes
No
Were you able to understand your doctor and the instructions given to you?
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Yes
No
Did your doctor completely answer all of your questions?
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Yes
No
If no, please explain:
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Would you recommend our office to your friends and family?
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Yes
No
Please use this field for additional comments regarding your visit, our staff, or our office.
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How did you hear about our survey?
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Email from Practice
Employee Recommended
Saw it while visiting the website
Would you like to be contacted regarding your visit?
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Yes
No
Name
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First
Last
Phone Number
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Email
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