APG Care

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Patient Satisfaction Survey

It is our goal to give you the best possible medical care. To do that, it is important that we know your thoughts about the care you are receiving. We need to know the areas in which we are doing well and the areas we need to improve. Your comments are strictly confidential and results are used to accomplish quality improvement. Feel free to make any comments below:

Is this your first visit to our practice or a return visit?   first visitreturn visit

Which provider did you see?  

Why did you decide to seek medical treatment at this practice? (check all that apply) sent by the emergency roomreferred by a friendselected physician from insurance listreferred by Workers' Compensationreferred by another patientreferred by another providernear my office or homeother:

If you selected "other" in the previous question please provide details:  

How many days in advance did you schedule your appointment?  

Did you want to be seen sooner?   yesno

Additional Comments:

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