7:30 a.m. to 4:30 p.m.
Monday - Friday
 
Patient Satisfaction Survey

Thank you for choosing our dermatology practice for your skin care needs. In order to provide the best possible service to our patients, we need your help. Please take a few minutes to share your opinion about our services with us. After completing this short questionnaire, use the 'Submit' button below to send to us by email. Please fill out the survey with today's visit and provider in mind.

We encourage your sincere, candid remarks and will keep all information you provide us strictly confidential. All comments and recommendations are welcome, and are used to continually improve our patient services. Thank you for your time.

 
Date:
Provider:
 Gary B. Slaughter, Jr., M.D.
 Daniel M. Lewis, M.D.
 Hazem M. El-Gamal, M.D.
 Mary Cummins, PA-C
Ability to schedule an office visit
 Great  Good  Ok  Fair  Poor
Available office hours
 Great  Good  Ok  Fair  Poor
Convenience of office location
 Great  Good  Ok  Fair  Poor
Prompt return calls (when messages left)
 Great  Good  Ok  Fair  Poor
Time in reception area
 Great  Good  Ok  Fair  Poor
Time in exam room
 Great  Good  Ok  Fair  Poor
Prompt return of test results
 Great  Good  Ok  Fair  Poor
PROVIDER: Listens to you
 Great  Good  Ok  Fair  Poor
Takes enough time with you
 Great  Good  Ok  Fair  Poor
Explains what you want to know
 Great  Good  Ok  Fair  Poor
Answers questions
 Great  Good  Ok  Fair  Poor
CLINICAL STAFF: Friendly and helpful
 Great  Good  Ok  Fair  Poor
Answers questions
 Great  Good  Ok  Fair  Poor
FRONT OFFICE STAFF: Friendly and helpful
 Great  Good  Ok  Fair  Poor
Answers questions
 Great  Good  Ok  Fair  Poor
FACILITY: Clean and sanitary
 Great  Good  Ok  Fair  Poor
Ease of access and parking
 Great  Good  Ok  Fair  Poor
Comfort and safety
 Great  Good  Ok  Fair  Poor
Ease of access and parking
 Great  Good  Ok  Fair  Poor
Privacy
 Great  Good  Ok  Fair  Poor
What is the likelihood of referring friends to us?
 Great  Good  Ok  Fair  Poor
If not, why?
Do you consider this center your regular source of skin care?
 Yes
 No
If not, why?
Suggestions for improvement?
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