Midlands Cardiology Group, P.C.

Patient Feedback Form

Your feedback is important to us.

First/Last Name
Email address
Who was your treating physician?	Dr. Ahmed Kutty Dr. Alain Efstratiou Dr. Iyad Azzam
When did you visit us last?	1 month ago 3-6 months ago 7-12 months ago
When you telephoned our office, did the receptionist answer your call courteously?
Yes No
Have you ever telephoned our office and received no response?
Yes No
Did you receive an appointment within a reasonable length of time?
Yes No
Upon arrival, did you find a convenient parking space?
Yes No
Did you have difficulty locating our office?
Yes No
Upon arrival, did the receptionist greet you courteously?
Yes No
Are the chairs and furnishings in our reception room satisfactory?
Yes No
Did you like the selection of magazines in our reception room?
Yes No
Were our assistants courteous, pleasant, helpful, and efficient in conducting you to an examining room?
Yes No
Upon arrival for your appointment, how long did you wait before beginning the history and/or examination?
Less than 30 minutes 31 - 60 minutes More than 60 minutes
Were you satisfied with the level of care and attention you received?
Yes No
How would you rate the doctor on his patience, warmth, and interest in your problem?
Good Hurried Poor
How would you rate the doctor on professional thoroughness in the examination?
Better than average Average Poor
After hours, have you ever had difficulty in reaching the doctor in an emergency?
Yes No
Did you understand the doctor's explanation of the results of your office visits?
Yes No
Did you have difficulty understanding our insurance form and statement?
Yes No
Comments