BayWellness Winter 2012 : BC 2
Please mark the box(es) below to indicate the office(s) where you receive care. ❏ Family Medicine (Old Bridge) ❏ Behavioral Health -Location: ❏ Old Bridge ❏ Perth Amboy ❏ OB/GYN -Location: ❏ Woodbridge ❏ South Amboy Please circle one of the following -always, usually, sometimes, never -as it relates to the question below. How often are you treated with courtesy and respect when interacting with the office staff and the physicians? Always Usually Sometimes Never How often do you get the appointment time you request? Always Usually Sometimes Never Please circle one of the following on a scale of 0-5, 0 being the worst and 5 being exceptional: How would you rate the overall care you receive by the providers/physicians? 0 1 2 3 4 5 How would you rate your overall experience? 0 1 2 3 4 5 Would you recommend this practice? Yes or No Comments/Suggestions __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ If you would prefer to give me your opinions personally, please call Denise Cruz, Director Practice Operations 732-324-6028.
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