Patient Satisfaction Survey Please take a few minutes and complete our Patient Satisfaction Survey. We strive to provide superior, state-of-the art care to our patients. Your input is very important in an effort to improve the quality of our services. We appreciate your time and feedback. Step 1 of 3 33% Please list your Health Care ProviderOffice Location - EarWell Centers of ExcellenceDallas, TexasPlano, TexasSouthlake, TexasAustin, TexasHouston, Texas Location 1Houston, Texas Location 2Houston, Texas Location 3How did you find us?Your website onlineReferral from a doctorReferral from family or a friendReferral from one of our patientsReferral from a parents support groupReferral from a colleague at workReferral from my insurance companySocial MediaFacebookInstagramD MagazineFort Worth Texas MagazineTop Doctors Texas Monthly MagazineTop Doctors™ US News and World Report/Castle ConnollyPatients' Choice Award: Patients Choice.orgMom Approved Doctor: Dallas Child MagazineSuper DoctorTop 10 MDZocdocPrint AdsRadio, TelevisionOther Web Source_____________________Scheduling your appointmentMethod of scheduling your appointmentOnline Appointment RequestPhone CallHow soon were you called after your online request?Within 1 working dayWithin 2 working daysI did not receive a return callWe strive to be prompt, however sometimes technology fails. We apologize for any delay or you not receiving a return call. Ease of scheduling your appointmentExcellentVery GoodGoodFairPoorNot ApplicableCourtesy of the staff who answered your callExcellentVery GoodGoodFairPoorNot ApplicablePromptness in returning your callExcellentVery GoodGoodFairPoorNot Applicable Arrival, Check-In and Wait TimeEase at finding our office and parkingExcellentVery GoodGoodFairPoorNot ApplicableStaff courtesy and helpfulness upon arrivalExcellentVery GoodGoodFairPoorNot ApplicableComfort in waiting areaExcellentVery GoodGoodFairPoorNot ApplicableWere you seen within a reasonable timeExcellentVery GoodGoodFairPoorNot ApplicableCommunication about delay, if anyExcellentVery GoodGoodFairPoorNot ApplicablePatient Care Services / ExaminationHow long was your wait?15 min30 min45 min60 minOver an hourPromptness of returning your phone callsExcellentVery GoodGoodFairPoorNot ApplicableCourtesy and helpfulness of our clinical staffExcellentVery GoodGoodFairPoorNot ApplicableWas our staff knowledgeable in answering your questions?ExcellentVery GoodGoodFairPoorNot ApplicableCourtesy of the health care provider treating youExcellentVery GoodGoodFairPoorNot ApplicableHow clearly did your health care provider explain your exam/results and treatment?ExcellentVery GoodGoodFairPoorNot ApplicableHow helpful were the home care instructions?ExcellentVery GoodGoodFairPoorNot Applicable Billing, Check-out and Follow-upCourtesy and helpfulness of our office Insurance ProviderExcellentVery GoodGoodFairPoorNot ApplicableEase of scheduling your follow-up appointmentExcellentVery GoodGoodFairPoorNot ApplicableCourtesy and helpfulness of your account representativeExcellentVery GoodGoodFairPoorNot ApplicableEffectiveness in explaining chargesExcellentVery GoodGoodFairPoorNot ApplicableWould you like us to contact you to discuss any issues? (Optional) Yes No We genuinely care about your experience and would like feedback from you on how to improve your time with us. We Care! Name First Last PhoneEmail Comments/Suggestions Federal and State Health Privacy and Security Notice: Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed. Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send to us. No one can diagnose your condition from email or other written communications, and communication via our website cannot replace the relationship you have with your physician. ~ Thank you! Secure Entry
