Pottstown Medical Specialsts, Inc.

Pottstown Medical Specialists, Inc. is dedicated to providing quality health care services to you. Please take a moment and let us know how we are doing.

What is your e-mail address:

(required)

Which office did you visit?

Which provider did you see?

How many miles did you travel to get to our office?

Under 1 Mile
1 to 3 Miles
3 to 5 Miles
5 to 10 Miles
over 10 Miles

Which of the following influenced your decision to use our office? (check all that apply)

Referred by another patient
Referred by a doctor
Referred by a friend or family member
Physician Referral Service
Doctor Participates in your HMO
Telephone Listing
Close to home or office
Other (please specify)

What health insurance do you have?

Medicare
Medicaid
Blue Cross/Blue Shield
Aetna/US Healthcare
Cigna
Keystone
Personal Choice
Other

How long did you wait to be seen by the physician?

under 15 minutes
15 to 30 minutes
30 to 45 minutes
45 minutes to 1 hour
over 1 hour

Please rate us:	Excellent/Good	Average	Below Avg/Poor	N/A
Courtesy and helpfulness of receptionist when you called to make your appointment
Ability to get a timely appointment
Office location
Parking availability
Courtesy and knowledge of staff:
Receptionist
Phone Nurse
Schedulers
Billing
Floor Nurse
Medical Records
Courtesy of provider
Provider's patience and interest in your problem
Time our professionals spent with you
Provider's explanation and treatment
General quality of medical care you received
Other:

Additional Comments: