Patient Satisfaction Survey

We hope that you have had a comfortable and pleasant experience in our office. We would greatly appreciate it if you would take a moment today to share your impression of our practice. We are always striving to provide outstanding service, and your feedback helps us to do that.

1. Did you make an appointment request online?
2. If you called for an appointment, was the scheduler helpful and courteous?
3. At check-in, was the receptionist helpful and courteous?
4. Was the medical assistant who brought you into the exam room helpful and courteous?
5. Was your healthcare provider (Dr. Dumois or Tina) helpful and courteous?
6. Did you understand your treatment?
7. Was the scheduler/check-out coordinator helpful and courteous?
8. If additional testing was ordered, were your questions answered?
9. How would you rate your overall wait time?
10. Overall, how would you rate your visit to our office?
11. If you answered “no” to any of the above questions, please explain.
12. Please tell us if there was any part of your visit that exceeded your expectations
13. Is there a staff member who you would like to recognize as going above and beyond your expectations?
14. Do you have any other suggestions or comments that would help us to make your visit to our office better?
15. Would you allow us to publish your comments on our website?
16. If so, how would you like us to sign your name, i..e., anonymous, First name and last initial, etc.

Thank you for your input, and many thanks for choosing us to provide your GI care.

Special thanks to those of you who recommend us to your family and friends.


If you would like to speak to the office manager directly, please contact Lisa Samuels at or call (407) 395-7040 ext 1501.