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PATIENT FORMS

Patient Survey

At Fernando Ibarra MD Inc, we are committed to providing you with the best healthcare. The quality of your experience with our gastroenterology practice and your outcome are equally important. You can help us evaluate our performance and improve our service. Please let us know about your experience with us by completing and submitting the Patient Satisfaction Survey below.



Was this your first visit to our office?  

On a scale of 1-5 with 5 being Excellent, please rate your last visit with us.
(1 –Very Poor 2- Poor 3-Average 4-Good 5-Excellent)

  1 2 3 4 5
Ease of setting your appointment.The length of time you waited for an appointment  
Greeting by our receptionist when you arrived  
Cleanliness/neatness of the waiting room  
Cleanliness/neatness of the procedure suite  
The length of time you spent waiting at the office to be seen by the physician  
Friendliness and caring of our office staff  
Friendliness and caring of the physician  
The skill and competence of the physician  
Quality of the service performed  
Degree to which your concerns were addressed by either the technician or the physician  
The usefulness of the instructional and educational materials you were given Overall  
Would you recommend Fernando Ibarra Md Inc?  
   

Please Note: Any information submitted using this form is transmitted securely and confidential