Dear Patient:
In an ongoing effort to improve your experience with our office, we would greatly appreciate it if you would take a few moments to answer the following questions.

Thank you!

Bakersfield
Delano
Tehachapi

What was the reason/purpose of your visit?

Yes
No

Yes
No

If NO, please explain:

Yes
No

If NO, please explain:

Yes
No

If NO, please explain:

How long did you have to wait before being seen?

Yes
No

If NO, please explain:

Yes
No

If NO, please explain:

Yes
No

If NO, please explain:

Overall, how would you rate your visit to our office?

Yes
No

Additional Comments: