Baldwin Park Family Practice, P.A. | Physicals, Minor Surgery, Aesthetics

1040 Woodcock Road, Suite 200 Orlando, Florida 32803
Phone: 407.898.4550 Fax: 407.898.4842

Patient Satisfaction Survey

E-mail Address:*

Name:

How would you rate Your wait time?

Poor - Waited too long.
Fair - Ok, but could be shorter.

Good - As expected.
Excellent - Great timing.

How would you rate the friendliness of our Staff?

Poor - Not at all friendly.
Fair - Somewhat friendly.

Good - As Expected.
Excellent - Very Friendly.

Was your problem addressed?

No, it was not.
Somewhat so.

Yes, it was.
Very much so.

Are you satisfied with your visit?

No, not at all.
Somewhat satisfied.

Yes, I'm satisfied.
Very Satisfied.

Do you have any suggestions or comments?

Would you like more information on any of the following treatments we provide? (Please select any or all services which interest you)
	Botox® Physician Directed Weight Loss Programs Microdermabrasion Facial Peels Skin Care Products Vitamin & Weight Control Supplements

Would you recommend our office to your friends & family?

Yes

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