Francis Holistic Medical Center, P.C.

Francis Holistic Medical Center Feedback


First Name
Last Name
Patient Name (if different)
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone	() -
Evening Phone	() -
E-mail Address
Patient Gender
Patient Age
What service did you come in for with this visit?
What time of day did you come in?
How many times (approx.) have you visited our center?
Please rate the courtesy of our receptionist (very courteous, somewhat courteous, neutral, somewhat discourteous, rude).
How long was your wait for your appointment?
Please rate the proficiency of the Nursing staff (Outstanding, Good, Adequate, Needs Improvement, Poor, N/A)
How would you rate the ability of the nurse/medical assistant in making you feel comfortable (Outstanding, Good, Adequate, Needs Improvement, Poor, N/A)?
Would you recommend this facility and its staff to your family and friends? If no, why?
If you have visited our website, how would you rate the design and ease of use (Superb, Good, Adequate, Needs Improvement, Poor, N/A)?
If you were given a laboratory testing kit or requisition form, were our instructions clear, accurate, and thorough (Outstanding, Good, Adequate, Needs Improvement, Poor, N/A)?
What do you like most about our service(s)?
Please list any areas in which our service could be improved.
Please share any additional comments.

Thank you for taking the time to fill out our survey. We rely on your
feedback to help us improve our services. Your input is greatly appreciated.