Allergy and Asthma Medical Group of the Bay Area, Inc.

Allergy & Asthma Medical Group Survey
Required Required Question(s)
Required 1.

Which office is this survey regarding?

 
Walnut Creek
San Ramon
Pleasanton
Brentwood
Berkeley
  • Comment:

  • 500 characters left.
2.

How long have you been a Patient of Allergy & Asthma Medical Group? 

 
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
3.

How often do you visit our office?

 
Weekly
Monthly
Quarterly
Yearly
Less than Once a Year
4.

How would you rate your overall level of satisfaction with us?

 
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
5.

How do we rate on the following attributes?

 

 
 Well Below Average Below Average Average Above Average Well Above Average 
Customer service experience
On-time delivery of service
Professionalism
Scheduling appointment experience
Quality of service
Understanding your needs
Payment Process
6.

How do we rate in comparison to other medical clinics that you visit?

 
Much higher
Somewhat higher
Same
Somewhat lower
Much lower
Don't know
7.

What brought you to visit our office?

 

 

 
Allergy Shot Patient
Asthma
Food Allergy
Nasal Allergy
Allergic Reaction
Other  
  • Comment:

  • 500 characters left.
8.

Were you referred by:

 

 
Physician (Please list name in comment box below)
Friend
Family Member
Other  
  • Comment:

  • 500 characters left.
9.

How likely are you to continue using our services?

 
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
10.

Have you ever recommended us to others?

 
No, never recommended
Have recommended once or twice
Have recommended several times
11.

Do you have any suggestions for improvement?

 
 

  • 350 characters left.

Optional Questions:

 

 
 
12.

What is your age?

 
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
13.

What is your gender?

 
Male
Female