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Patient Satisfaction Survey

About Your Visit

Dear Patient


At Doctor's Weight Loss Clinic, we are committed to healthcare. We are interested in knowing what you think about our services. Please take a minute to complete this brief survey. Your responses are confidential and are greatly appreciated. Thank you.      

Please rate each of the following:                                                                                    

1. Please select your patient status:
2. Please select your level of satisfaction on the following:
Space Cell PoorFairGoodExcellent
Friendliness/courtesy of the care provider
Did we explained the services you needed in an understandable manner?
Concerns the care provider showed for your questions or worries
Information the care provider gave you about medications (if any)
Instructions the care provider gave you about follow-up care (if any)
Overall how satisfied are you with the services you received from us?