Which office are you evaluating? (Select one)

Inverness Office     Crystal River Office    Lake Sumter Landing Office     Leesburg Office

Date of Visit:

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Please read each question carefully, and indicate what best describes your visit or experience.

Were you able to schedule your appointment as soon as you wanted? Yes     No Was this your first visit to Citrus Cardiology? Yes     No Were you greeted and treated courteously by reception when you arrived? Yes     No How long after your scheduled time did you wait to see your physician? 1-10 min.     11-20 min.     21-30 min.     Over 30 min. Were the exam rooms and lobby clean and tidy? Yes     No When you saw your physician, were you given a chance to explain the reasons for your visit? Yes     No When you asked questions, did you get an answer you could understand? Yes     No Did your physician explain the purpose or results of any tests or procedures in a way you could understand? Yes     No     Did not need tests or procedures Did someone explain the purpose of any medication(s) in a way you could understand? Yes     No     Did not need medication Did someone explain any side effects of the medication(s) in a way you could understand? Yes     No     Did not need medication Did your physician explain what to do if problems or symptoms continued, got worse, or returned? Yes     No Were you involved in decisions about your care as much as you wanted? Yes     No Was your physician familiar with your most recent medical history? Yes     No Did you have confidence and trust in the physician you saw? Yes     No Did you have trouble understanding your physician because of language differences? Yes     No Were you treated with courtesy and respect by your physician during your visit? Yes     No Were you treated with courtesy and respect by the staff during your visit? Yes     No Overall, how would you rate the quality of care you received during your visit? Excellent     Very Good     Good     Fair     Poor Overall, how would you rate the office, staff and physicians? Excellent     Very Good     Good     Fair     Poor Please feel free to share any comments you have about your recent visit, or let us know anything we can do to make this practice better for you and your family.

Your name and email address is required below. All information will be confidential and used only by Citrus Cardiology Consultants, P.A. as a guide to serve their patients better.

Thank you for taking the time to share your experience with us today.