Comprehensive Internal Medicine

Johns Creek
 3890 Johns Creek Pkwy
Suite 360
Suwanee, GA 30024
(770) 622-9002
(770)622-9004 fax


Alpharetta
 11975 Morris Rd
Suite 140
Alpharetta, GA 30005
(678) 205-9004
(678)205-9005 fax






Comprehensive Internal Medicine

Patient Satisfaction Survey

To ensure that we are meeting your needs we would like to know how you feel about the services that we provide.  Your responses are directly responsible for improving our services.  All responses will be kept confidential and anonymous.  Thank you for your time. 


Your email address:   Your email address is needed for verification purposes only. Your information is secure. Comprehensive Internal Medicine will never sell, distribute or disclose your email to anyone.

THE FACILITY
Easy to find?    Excellent    Good  OK     Fair  Poor
Rooms neat & tidy?   Excellent    Good  OK     Fair  Poor
Your comfort while here:  Excellent    Good  OK     Fair  Poor

THE APPOINTMENT PROCESS
Ease of getting an appointment: Excellent    Good  OK     Fair  Poor
Politeness of the person making your appointment: Excellent    Good  OK     Fair  Poor

WAITING TIME
Time spent in the waiting room:  Excellent    Good  OK     Fair  Poor
Time spent in the examining room:   Excellent    Good  OK     Fair  Poor

YOUR DOCTOR OR PHYSICIAN ASSISTANT
Understood what you said:   Excellent    Good  OK     Fair  Poor N/A
Took enough time with you:    Excellent    Good  OK     Fair  Poor N/A
Taught you about your condition:  Excellent    Good  OK     Fair  Poor  N/A
Explained why labs were performed:  Excellent    Good  OK     Fair  PoorN/A
Explained how to take your medications:  Excellent    Good  OK     Fair  PoorN/A
Explained ways to stay healthy:   Excellent    Good  OK     Fair  Poor N/A

SATISFACTION WITH STAFF
Receptionists: Excellent    Good  OK     Fair  Poor N/A
Medical Assistants:  Excellent    Good  OK     Fair  Poor N/A
Physicians:  Excellent    Good  OK     Fair  PoorN/A
Physician Assistant:  Excellent    Good  OK     Fair  Poor N/A
Insurance & Billing Staff:  Excellent    Good  OK     Fair  PoorN/A

WHAT IS THE LIKELIHOOD THAT YOU WOULD REFER YOUR FAMILY & FRIENDS TO US?
Excellent    Good  OK     Fair  Poor

Please indicate the reason that you are leaving the practice:
Insurance Change    Moved out of the area  Switched to Another Doctor
 

Which doctor did you normally see?     

Which office do you go to?

OPTIONAL:    Sex:       AGE:


Have you had a good experience with CIM? A bad experience? How can we improve? Tell us about it!