Office Visit Survey Template This is only a survey preview. You cannot respond to this version of the office visit survey. Visit Survey Share for business survey templates including office visit survey templates.

1) What was the purpose of your visit to our office? 2) Did you have an appointment? Yes No 3) How long did you have to wait before you were seen by a representative? -- Select Here -- Less than 5 Minutes 5-10 Minutes 11-20 Minutes 21-30 Minutes More than 30 Minutes Please tell us how satisfied or dissatisfied you were with each of the following: 4) How satisfied were you with the way you were treated by the staff at our office? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 5) How satisfied were you with the amount of time you had to wait before being seen by a representative? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 6) How satisfied were you with the way your questions were answered? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 7) How would you rate the courtesy you were shown by staff at our office? Excellent Good Fair Poor Don't Know Please tell us how much you agree or disagree with the following statements: 8) The staff were knowledgeable. Strongly Disagree Disagree Undecided Agree Strongly Agree 9) The staff were friendly and courteous. Strongly Disagree Disagree Undecided Agree Strongly Agree 10) My questions were answered fully. Strongly Disagree Disagree Undecided Agree Strongly Agree 11) I was given complete attention by the office representative. Strongly Disagree Disagree Undecided Agree Strongly Agree 12) My visit to the office was a pleasant experience. Strongly Disagree Disagree Undecided Agree Strongly Agree 13) Overall, would you say your visit to our office was very positive, somewhat positive, somewhat negative or very negative? Very Positive Somewhat Positive Undecided Somewhat Negative Very Negative 14) What, if anything, did you like most about your visit to our office? 15) What, if anything, did you like least about your visit to our office? 16) Please tell us what, if anything, we can do to make future visits to our office more enjoyable for you.

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