Patient Experience Survey

This survey will provide us with valuable information on how we can enhance our services. (All submissions are anonymous.)

1. Were you satisfied with your recent visit to Urology Associates of Fredericksburg?*
- Yes
- No
2. Who was your provider?*
- Dr. Carey
- Dr. Beamon
- Dr. Becker
- Dr. Sell
- Dr. Hoffman
- Dr. Szlyk
- Dr. DuMont
3. When you arrived in our office, were you greeted and treated in a professional manner?
- Yes
- No
4. Please rate you level of satisfaction with how you were treated by the staff and nurse.*
- Excellent
- Acceptable
- Needs Improvement
5. Please rate your satisfaction with the instruction and or explanation given to you by your provider during your visit.*
- Excellent
- Acceptable
- Needs Improvement
6. Please rate the time and attention you received from your provider during your visit.*
- Excellent
- Acceptable
- Needs Improvement
7. When you checked out, was that process handled professionally and efficiently?*
- Yes
- No
8. Would you recommend Urology Associates to a friend?*
- Yes
- No
Please add any comments or suggestions
Please leave your information below so that we may contact you regarding your experience.*
Name Phone E-mail
***Your information is private and will not be available to the public.***