Website Feedback

Our website is new and we ask for your help in making more useful. Your feedback is important to us. Your responses are anonymous and will not be shared outside our practice. Thank you for taking our survey.

What is your relationship to this practice?
Current patient
Potential patient looking for a physician
Referring physician
Other (please specify):
How did you learn about our practice?
Internet search
Physician referral
Friend or relative
Other (please specify):
How did you learn about our website?
Internet search
A staff member at the practice
Someone outside this practice (for example, a friend, family member, or referring physician)
Other (please specify):
What type of information did you find most valuable on our website?
Information about our physicians
News items
Services we provide
Location, hours, insurance, etc.
Educational information about conditions and procedures performed
Other (please specify):
Which of the following services, if they were available on our website, would you be most likely to use?
Request an appointment on-line
Request a prescription renewal on-line
Request my records on-line
Complete registration forms on-line (interactive forms)
Pay my account on-line
Create a personal profile and page on your website
Other(please specify):
Please provide us with any other feedback that would help make our website more useful to you.