Jasleen Duggal, MD, FACP
ENDOCRINOLOGIST

Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving these services.  All responses will be kept confidential and anonymous.  Thank you for your time.

Please select the rating on how well you think we are doing in the following areas:

                                                 RATINGS:
                   GREAT = 5    GOOD = 4    OK = 3    FAIR = 2    POOR = 1 


Ease of getting care: Ability to get in to be seen.


Office: Hours office is open.

Waiting: Time in waiting room/exam room.

Provider:(Physician/Physician Assistant): Listens to you.

Provider:(Physician/Physician Assistant):Takes enough time with you.


Provider:(Physician/Physician Assistant):Gives you good advice and treatment.


Staff: (Medical Assistant/Administrative):Friendly and helpful. 


Staff: (Medical Assistant/Administrative):Answers your questions.

Communication: Prompt on return calls.


The likelihood of referring your friends and relatives to us?

Additional Comments:



Contact Information 

If you would like to be contacted by our Group Quality Manager to discuss your visit or provide more information that will help us improve our services to meeting your needs please provide us your contact information below.  Thank you.

First Name:
Last Name:
Daytime Phone:
Evening Phone:
Email:
Special instructions on how best to contact you:

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