Dr.Daniel Hakimi | OB/GYN & Infertility Specialist | Services Of Northern NJ » Patient Survey

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Patient Survey

The management at Ob/Gyn & Infertility wants to let you know that you are important to us and your opinion certainly matters to us. Thanks in advance for taking the time to fill out this brief survey. Without an input from our family members (you as a patient) we can never achieve our goal of  constantly improving and maintaining our highest quality of care.





Was this your first visit to our office?
What was the purpose of your visit?
On a scale of 1-5 with 5 being Excellent, please rate your last visit with us.
(1 – Poor 2- Fair 3-Good 4- Very Good 5-Excellent)
Ease of setting your appointment
54321
Greeting by our receptionist when you arrived
54321
Cleanliness/neatness of the waiting room
54321
Cleanliness/neatness of the procedure suite
54321
Length of time you had to wait before you were called for your appointment
54321
Friendliness of our office staff
54321
Friendliness of the physician
54321
Ability of physician to put you at ease
54321
Quality of the service performed
54321
Degree to which your concerns were addressed by either the technician or the physician
54321
The ease of checking out and paying after the appointment
54321
In your own words, let us know any positive experiences you had or issues or concerns you may have about our services or office practices and procedures.
How likely is it that you would recommend our office to your family members, co-workers, and friends?
54321
Do you like to provide us with your contact information?
YESNO
Please Note: Any information submitted using this form is transmitted securely and held in strictest confidence, protecting your privacy.

 

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When You Feel Good, We Feel Good!