Dr. Fodero - Plastic Surgery Consultation Survey

First Name:
Last Name:
Address me as:
Email:

1. How satisfied are you with:
	Dissatisfied	Somewhat Dissatisfied	Satisfied	Highly Satisfied
The sign-in process:
The timeliness of your appointment:
The way information was shared with you:
The overall care given by staff:
The overall care given by doctor:

2. How much do you agree with the following?
	Dissatisfied	Somewhat Dissatisfied	Satisfied	Highly Satisfied
The doctor treated me with respect:
The doctor listened to me:
The doctor seemed to care about my feelings:
The doctor and staff worked well as a team:
The doctor told me all I need to know:
The staff helped me when I needed help:
I felt comfortable asking questions:
I was comfortable during the exam:
I understand the proposed treatment plan:
I know who to call if I have questions: