1. Please rate the pre-procedure instructions given to you by our staff… 1. Please rate the pre-procedure instructions given to you by our staff…PoorFairGoodExcellent

2. Please rate the professionalism and courtesy of the receptionist and business office personnel… 2. Please rate the professionalism and courtesy of the receptionist and business office personnel…PoorFairGoodExcellent

3. I received adequate information about financial agreements… 3. I received adequate information about financial agreements…PoorFairGoodExcellent

4. The waiting time was appropriate… 4. The waiting time was appropriate…PoorFairGoodExcellent

5. Please rate the post-procedure instructions you were given… 5. Please rate the post-procedure instructions you were given…PoorFairGoodExcellent

6. The doctors and staff explained things so that I could understand… 6. The doctors and staff explained things so that I could understand…PoorFairGoodExcellent

7. Was effort made to maintain your privacy? 7. Was effort made to maintain your privacy? Yes No

8. Would you recommend our Center to family or friends? 8. Would you recommend our Center to family or friends? Yes No

9. Would you use our facility again? 9. Would you use our facility again? Yes No

10. What did you like most about our Center?

11. What did you like least about our Center?

12. Please list any general comments, suggestions or employees who provided exceptional service.

13. From a scale of 1-10 (10 being the best) how would you rate your overall care? 13. From a scale of 1-10 (10 being the best) how would you rate your overall care? 12345678910