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Patient Satisfaction Survey

Your satisfaction is important to us. To help serve you better, please take a minute to complete this questionnaire. We appreciate your choosing us as your healthcare provider.

Please read the following sentences, then choose whether you agree or disagree

  1. The person I spoke with on the phone was helpful and courteous
  2. The number of days I had to wait to get an appointment was excessive
  3. The receptionist who greeted me was helpful and courteous
  4. The length of time I waited in the reception area was excessive
  5. The length of time I waited in the exam room was excessive
  6. The amount of time the physician spent with me answering my questions was adequate for my needs
  7. The physician treated me with dignity and respect
  8. The appearance of the office/exam rooms was clean and pleasant
  9. I am pleased with the quality of care I received from the physician
  1. Is your privacy maintained during your visit?
  2. How are you generally treated by the staff during your visits?
  3. When you leave the office, do you feel you have adequate information concerning the state of your health or condition?
  4. Do you understand what your financial responsibility to the practice is?
  5. What would make your experience with us more pleasant?
  6. If a friend needed the services we provide, would you recommend us?


701 Cottage Grove Road
Building C110
Bloomfield, CT 06002
Toll free: 1.866.MYEZVAS
Fax: 860.242.2250


Monday - Friday
9:00 am - 5:00 pm

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