Thank you for taking the time to fill out this survey. Include your name and email if you wish to receive promotional offers for your next visit.

What is your name?
What was the date of your most recent appointment?
How would you rate our Office Location?




How would you rate the parking space provided for our facility?




How would you rate our Front Office check-in?




How would you rate our Front Office check out?




How would you rate our appointment availability (were you able to get a preferred time slot)?




How would you rate our telephone courtesy?




Our nursing staff was courteous:




Our Nursing Staff was informative:




Our Nursing Staff was gentle with procedures:




Dr. Ghohestani was friendly




Dr. Ghohestani was able to explain my diagnosis:




Dr. Ghohestani answered all my questions:




Dr. Ghohestani was knowledgeable:




Dr. Ghohestani took enough time with me:




Would you return?


Would you recommend us?


How did you find out about us?





If you were referred, whom may we thank for referring you?
Did you receive a reminder card to return for your visit?


Did you recieve a phone call reminder about your appointment time?


If you had lab/biopsy, were you notified promptly of your results?


Were all your questions answered?


Did your bill make sense?


Do you understand how to use your medicines?


Did you receive samples?


Have you purchased cosmetic skin care products from us?


Did you understand how to use them?


Is our website (www.txid.org) informative?


Have you had any cosmetic procedures performed prior to this visit?


How long did you have to wait before you were seen by a representative?





Which of the following procedures are you interested in learning more about?
















What was the purpose of your last visit?

What would you like to learn more, if anything, about in regards to our services?

What would you suggest, if anything, we do differently to make your visit better?

What was the best thing about your visit?

What was the worst thing about your visit?

Which local radio station do you listen to most frequently?











Which time frame do you listen to the radio the most?







Where do you most frequently listen to the radio at?




Which local television station do you most frequently watch?






Which time frame do you most frequently watch television?