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Patient Feedback Survey

Thank you for your trusting Digestive Disease Associates. In an effort to help us continue to provide patient-centered care, please complete the survey below, and let us know about your experience.

Patient Feedback Survey

Patient Feedback Survey

Simply fill out the form below and click submit when you are done.

Treating Physician*
Location of Visit*
Date of Visit*
Date Format: MM slash DD slash YYYY
Promptness in scheduling your appointment*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Friendliness of Staff
Friendliness of Physician*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Friendliness of Office Staff*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
General Office Visit
Promptness of answering phone*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Promptness of nurse or physician returning your phone call*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Time spent waiting in our office*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Overall comfort with our office staff*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Tests and procedures explained in understandable terms*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Tests and procedures explained in understandable terms*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Explanation of your illness and treatment*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Our staff's understanding of your insurance benefits*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Convenience of our office hours*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Convenience of our office locations*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Amount of time waiting for the physician*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Professional manner of our staff*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Professional manner of our staff*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
Your overall visit*
- Excellent
- Very Good
- Satisfactory
- Below Average
- Poor
What did we do well during your visit? Please feel free to highlight any staff member who went over and beyond to provide you exceptional customer service.
What suggestions do you have that might help us serve you better?
Would you like to be contacted regarding your care?*
Name
First Last
Email
Phone
You have my permission to post my comments online?*

CATONSVILLE

700 Geipe Road, Suite 230
Catonsville, MD 21228

COLUMBIA

Medical Pavilion at Howard County
10710 Charter Drive, Suite 110
Columbia, MD 21044

OPEN HOURS

Mon – Thurs — 8:00am – 5:00pm
Friday — 8:00am – 4:30pm
Phone hours: 8:00 – 4:30pm

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Today's Date*
Date Format: MM slash DD slash YYYY
Appointment Type*
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Email*
Physician
Preferred Date*
Date Format: MM slash DD slash YYYY
Preferred Time*

: HH

MM
Location / Office*
Primary Insurance*
Secondary Insurance
Are you a new or established patient at Digestive Disease Associates?*
- I am a new patient
- I am an established patient
How did you hear about us?*
- Referred by a physician
- Referred by a friend
- Email
- Online Search
- Received letter from Kimbrough Ambulatory Care
- Received colonoscopy reminder from Digestive Disease Associates
- Insurance company
- Health fair
- Advertisement
- Social Media
- Post Card in the Mail
- Other
If referred by a physician, please select the response that best applies
- I was referred specifically to Digestive Disease Associates
- I was referred to see a gastroenterologist, NOT specifically to Digestive Disease Associates
Name of Referring Physician*