Post-Consultation Questionnaire

Personal Information

As a result of your experience with our office, please indicate which of the following best describes your feelings or concerns. Select all that apply:



Are you satisfied with our practice?

If you decided to have surgery elsewhere, please indicate the most important factors in that decision.






We are particularly interested in knowing your reaction to our communications with you. Were you happy with:

How would you rate our contact with you?

We welcome your comments and suggestions:

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