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Urology Associates Patient Survey
Where did you have your appointment?
*
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Templeton
San Luis Obispo
Pismo Beach
Santa Maria
Please select an option
Which physician/PA-C did you see?
*
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Dr. Canfield, M.D.
Dr. Clayton, M.D.
Dr. Klosterman, M.D.
Dr. Kuntze, M.D.
Jennifer Eckerman, PA-C
Jessica Turner, PA-C
Sara Woodruff, PA-C
If you called us on the phone, was your call answered promptly?
*
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Yes
No
In the last 12 months, when you made an appointment for a check-up or routine care, how often did you get an appointment as soon as you needed?
*
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Always
Almost Always
Sometimes
Never
In the last 12 months, how often did this doctor explain things in a way that was easty to understand?
*
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Always
Almost Always
Sometimes
Never
Please Rate the Following:
Courtesy of the person who took your call?
*
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Excellent
Good
Fair
Poor
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Efficiency of the check-in process and paperwork?
*
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Excellent
Good
Fair
Poor
Comfort and cleanliness of our office?
*
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Excellent
Good
Fair
Poor
Courtesy and kindness of our Medical Assistants?
*
Please Select One
Excellent
Good
Fair
Poor
How would you rate your overall experience?
*
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Excellent
Good
Fair
Poor
Optional Contact Information
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Name
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Email
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