1.

Which office location did you visit?

Select an Option Merrifield / Falls Church Office Herndon / Reston Office

2.

Which Provider did you see?

Select an Option Ramesh Chandra, MD FACS Lonnie Davis, MD

3.

Are you a new or returning patient?

Select an Option New Patient Returning Patient

4.

How were you referred to our practice?

Select an Option Friend / Relative My Physician Insurance Site Internet Other N/A

5.

When scheduling and appointment, the staff was courteous and helpful.

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6.

I was able to make an appointment for a date and time that was reasonable and convenient to me.

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7.

I was greeted and registered promptly.

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8.

The registration staff was courteous and helpful.

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9.

The ability to access forms on the website made the registration process more convenient and efficient.

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10.

My healthcare provider was compassionate.

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11.

My healthcare provider gave me enough time to ask questions.

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12.

My healthcare provider sufficiently answered my questions.

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13.

My diagnosis and treatment was adequately explained.

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14.

The medical staff was professional and helpful.

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15.

I know the process to ask follow-up questions after my appointment.

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16.

I was able to easily schedule my next appointment.

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17.

Did we handle your payment properly?

Yes

No

18.

Were your phone calls returned within 24 hours?

Yes

No

19.

Did you visit our website before or after your appointment to learn more?

Yes

No

20.

What is your overall level of satisfaction with our practice?

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21.

Would you recommend CFSOM to a friend or family member?

Yes

No

22.

We welcome additional comments or recommendations on ways to improve our service: