Patient Evaluation Form At The Centre for Digestive Health, we are very interested in knowing what you think about our service. Please take a moment to help us learn what we do right and what we need to improve: Date of Your Visit Time of Your Appointment : HH MM AM PM PhysicianDr. MunningsDr. CarterWas this your first visit to our facility?YesNoName First Last Email How helpful was the person you spoke with on the phone?PoorFairGoodVery GoodEase of scheduling appointmentPoorFairGoodVery GoodI was greeted in a professional mannerPoorFairGoodVery GoodHow was the check in process?PoorFairGoodVery GoodThe waiting room was clean and comfortablePoorFairGoodVery GoodThe consultation and procedure areas were clean and comfortablePoorFairGoodVery GoodGiven clear and sufficient on what to do and what to expect for your procedure?PoorFairGoodVery GoodThe courtesy and caring of your physician?PoorFairGoodVery GoodTime spent with your physician?PoorFairGoodVery GoodMy main questions were addressedPoorFairGoodVery GoodI was comfortable with my treatment planPoorFairGoodVery GoodThe nursing and support staff were courteousPoorFairGoodVery GoodMy wait time was acceptablePoorFairGoodVery GoodI visited the practice website prior to my visit?YesNoThe practice website was easy to navigate and had the information I needed prior to my visit?PoorFairGoodVery GoodWould you recommend us to family and friends?DefinitelyMaybeProbably NotNo Way!Please add any comments you have regarding your visit: Δ
