Patient Satisfaction Survey

Dear Gilcrease Medical Group Patient: We hope your experience was a positive one as our goal is to provide you with the very best medical care possible. Please complete the following survey by checking one of the following: (Poor, Fair, Average, Good, Excellent)

Your Email (required)

Date of Appointment:

Provider Seen:

Ease of getting an appointment:

Staff listened & answered questions:

Timely response to phone calls:

Timely prescription refills:

Concern shown by doctor:

Amount of time spent with doctor:

Overall quality of care and services:

Time Waited in Reception Area:

Rate Your Time Waited in Reception Area

Time Waited in Exam Room:

Rate Your Time Waited in Exam Room:


Would you recommend our clinic to a friend?:


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