Eagle Physicians & Associates strives to meet the expectations of its patients by providing high quality care and outstanding service. Please help Eagle physicians and staff to continue meeting your needs, as well as identifying areas we can improve, by completing this form. Your responses will be kept confidential. Thank you for your assistance! CONCERNING YOUR MOST RECENT VISIT 1. Date of your most recent visit 2. Name of doctor or provider that you saw 3. Were you seen promptly? Yes No If NO, please explain: 4. Was the doctor or other provider you saw today:   Helpful? Yes No If NO, please explain:   Friendly? Yes No If NO, please explain:   Professional? Yes No If NO, please explain:   Properly Attired? Yes No If NO, please explain: 5. Were all staff members polite and helpful? Yes No If NO, please explain: CONCERNING YOUR OVERALL EXPERIENCE WITH EAGLE THIS PAST YEAR: 1. Typically, who is your personal Eagle doctor or provider? 2. How would you rate the quality of care you have received from Eagle providers?   EXCELLENT GOOD FAIR POOR NO OPINION 3. What is your overall satisfaction level with Eagle Physicians & Associates?   EXCELLENT GOOD FAIR POOR NO OPINION 4. What do you like and dislike about the specific Eagle doctor and office you visit regularly?   LIKE: DISLIKE: 5. Would you recommend the Eagle doctor that you regularly see to others? Yes No 6. Is there anything we do that irritates you? Yes No If Yes, please explain: 7. Do you have any specific suggestions or comments for improving our medical practices? 8. Name and contact information (optional) Thank you for completing our Patient Satisfaction Survey. Please submit this form and it will be sent directly to our office.