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Exit Survey »

 
 
* What was the date of your visit?
MonthDayYear
  
 
 
 
Was this your first visit to BVNS?
 
Yes
 
No
 
 
 
* Which office did you visit?
 
Atlanta, GA
 
Leesburg, VA
 
Richmond, VA
 
Rockville, MD
 
Springfield, VA
 
Vienna, VA

 
 
 
What was the reason for your visit:
 
Initial Appointment
 
Diagnostics and/or Surgery
 
Recheck
 
Other
    
 
 
Please indicate your level of satisfaction with the following aspects of our service.
Very Satisfied Satisfied Neutral Not Satisfied Very Dissatisfied
Availability of appointments
Wait prior to appointment
Customer service before your appointment
Quality of care provided by medical staff
Clearness of communication
Time required for medical treatment
Post-service follow-up
Overall experience
 
 
 
Please complete the following. Our service:
 
Exceeded my expectations
 
Was as I expected
 
Did not meet my expectations
 
 
 
Please feel free to provide comments/suggestions on our service:
   
 
 
 
Please rate how comfortable you are with the post-appointment instructions you were provided?
 
Very comfortable
 
Comfortable
 
Somewhat comfortable
 
Uncomfortable
 
 
 
Please feel free to provide comments/suggestions on the post-appointment instructions you were provided:
   
 
 
 
If you would like to comment on the performance of any individual group member please do so here.
   
 
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