Patient Satisfaction Survey

Please help us in providing you with the highest level of efficient, personalized care. We would greatly appreciate you taking a few moments to evaluate your experience with us. Please rate the following:

1. Accessibility	Excellent	Very Good	Good	Fair	Poor	N/A
Ease of getting through on the phone
Ease of scheduling an appointment
Wait time on the phone
Timeliness of return calls / emails
Wait time in the office

If Fair or Poor, please explain:

2. Communication	Excellent	Very Good	Good	Fair	Poor	N/A
In-office reference materials
Website Content
Billing & claims information
Patient financing information
Treatment & post care instructions

If Fair or Poor, please explain:

3. Customer Service	Excellent	Very Good	Good	Fair	Poor	N/A
Ambiance of Reception Area
Friendliness of office staff
Knowledge of front office staff
Helpfulness & caring of staff
Ease of payment processing
Follow-up phone calls

If Fair or Poor, please explain:

4. Consult & Treatment	Excellent	Very Good	Good	Fair	Poor	N/A
Concerns addressed properly
Time taken to discuss concerns
Explanation of the following:
Procedures
Risks
Alternatives
Treatment instructions
Comfort during treatment
Relief provided for any discomfort

If Fair or Poor, please explain:

5. Would you recommend a friend or relative for treatment at LazaDerm Skincare Centre?

Yes No

Please explain:

6. Comments

SIOUX FALLS LOCATION - (605) 275-6128
5011 S. Louise Avenue, Sioux Falls, SD, 57108

SIOUX CITY LOCATION - (605) 235-1630 or (800) 597-2095
383 West Steamboat Drive, Suite 103, Dakota Dunes, SD 57049