South Surgical Group
Dr. David Baer and Dr. James DeLine
Tell Us How We Can Serve You Better!
Using the legend below, please fill in the number following each question that corresponds with your answer.
For example, if your answer to the first question is "excellent", you will fill in the number "1". If you do not have sufficient
knowledge to answer a question, please fill in the number "6", don't know.
1 = Excellent
2 = Above Average
3 = Average
4 = Below Average
5 = Poor
6 = Don't Know