Charlotte
Concord
Rock Hill
Gaffney
Home
About Us
Our Providers
Fees & Insurance
Financial Policy
Hospital Affiliations
Accepted Insurance
Balloon Sinus Dilation
Balloon Sinus Dilation
Balloon Sinus Dilation FAQ
BSD Animation
Our Services
Ear, Nose & Throat
Ears, Nose and Throat (ENT)
Patient Education
Pediatric ENT
Allergy
Allergy Services
Patient Education
Kids & Allergy
Audiology
Audiology
What Is Audiology
Hearing Loss
Hearing Aids
Dizziness
Related Links
News & Announcements
Locations and Appointments
Online Survey
Please complete our online survey. We will use our feedback to help your office continue to give outstanding customer service and train on any areas that we need to improve on. Take a little time to complete the survey. We value what you say!
How would you rate your overall visit?
Please select
Outstanding
Great
Ok
Not good
If no, please explain
Did the Physician and/or PA address your concerns to your satisfaction?
Yes
No
Were you treated courteously by the front staff upon check-in?
Yes
No
Were you treated courteously by our clinical staff during your examination?
Yes
No
If no, Please explain.
Age group of patient:
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer Not to Answer
Sex
Male
Female
Race
African American
Caucasian
Indian
Asian
Hispanic
Would you recommend our facility in the future?
Yes
No
Additional comments:
Name
First
Last
Email
Home
About Us
▼
Our Providers
Fees & Insurance
▼
Financial Policy
Hospital Affiliations
Accepted Insurance
Balloon Sinus Dilation
▼
Balloon Sinus Dilation
Balloon Sinus Dilation FAQ
BSD Animation
Our Services
▼
Ear, Nose & Throat
▼
Ears, Nose and Throat (ENT)
Patient Education
Pediatric ENT
Allergy
▼
Allergy Services
Patient Education
Kids & Allergy
Audiology
▼
Audiology
What Is Audiology
Hearing Loss
Hearing Aids
Dizziness
Related Links
News & Announcements
Locations and Appointments
