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1. Who did you see today? Dr. Kiran Shah Dr. Alpa Shah
2. Did our front desk staff treat you with respect? Yes No
3. Was our front staff friendly? Yes No
4. Was our test technician knowledgeable and friendly? Yes No
5. Was it easy to schedule your appointment? Yes No
6. Did you experience any delays? Yes No
7. If yes, did we explain the delays? Yes No Does not apply
8. Was the facility clean and presentable? Yes No
9. My provider treated me with respect Strongly Agree Agree Neutral Disagree Strongly Disagree
10. I understood the treatment plan and follow-up Strongly Agree Agree Neutral Disagree Strongly Disagree
11. I felt comfortable asking my provider questions Strongly Agree Agree Neutral Disagree Strongly Disagree
12. I would recommend my provider to family and friends Strongly Agree Agree Neutral Disagree Strongly Disagree
13. What are we doing well?
14. Please tell us how we can improve include areas that you answered with "no" or "disagree"
15. Last question, How did you find us? Doctor Family member Friend Online search Insurance provider list Other
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