Survey

Please take a few minutes to complete our survey. Completing this survey will enable our staff to assist our patients in the most effective and most efficient manner. After completing the survey please click on the submit button at the bottom of the page. Thank you in advance for taking the time to complete our survey.

Survey Questionnaire
Name (Optional) Date of Birth  Click to view Calendar
Telephone Survey:
Please answer each question by clicking 'Yes' or 'No'
1. Did the Staff Professional identify him/herself on the telephone?
Name of Staff Professional 
2. Did the Staff Professional obtain and use your name effectively during the telephone conversation?
3. Did the Staff Professional convey a warm and inviting attitude?
Explain why or why not
4. Was the Staff Professional knowledgeable of the information that was being requested?
     If not, did he/she take your phone number or direct you to someone who could better assist your needs?
5. How would you overall rate the Staff Professional’s telephone customer service skills?
Office Visit Survey:
Please answer each question by clicking 'Yes' or 'No'
1. Did the Staff Professional establish a good rapport (relationship) with you while determining your medical needs?
2. Did the Staff Professional meet your medical needs in an effective and efficient manner?
3. How would you overall rate the office Staff at Extended Arm Physicians, Inc.?
4. How would you rate your medical treatment given by Extended Arm Physicians, Inc.?
5. How would you rate the Receptionist Area?
6. How would you rate the Nursing Staff?
7. How would you rate the Physician?
8. If you have attended the Extended Arm Research Department, how would you overall rate the research staff and the research department?
9. During your office visit, how would you rate the overall customer service provided by the staff Professionals?
Overall Comments


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About Us  
1725 W Fourth Street
Montgomery, AL, 36106 USA
Ph: 334.262.2071
Fax: 334.269.9777
Service - Stress Test, EKG, History and Physical, 24-Hour Holter Monitor Placement, Bone Density, PFT, Diagnostic Ultrasound
Forms - New Patient, Existing Patient
Copyright © 2006. Extended Arm Physicians, Inc. All rights reserved.