Patient Survey

Thank you for taking the time to help advance our clinic by providing feedback on the following areas.

Your First Name (optional)

Friendliness and courtesy shown by our front office staff:
(Excellent)54321 (poor)

Promptness of your appointment:
(Excellent)54321 (poor)

Quality of care provided by M.A., Nurse, P.A., or Doctor:
(Excellent)54321 (poor)

Your overall experience at AkHES:
(Excellent)54321 (poor)

Additional comments

I hereby authorize AkHES to use my first name and written comments in any and all media for internal and external marketing purposes.

I choose to remain anonymous and DO NOT agree to my comments being used in any media