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              South Surgical Group

 Dr. David Baer and Dr. James DeLine

    Specializing in General and Minimally Invasive Surgery

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

2. When you telephoned our office how would you rate the service you received over the phone?
3. How would you rate the ease and timeliness of getting an appointment?
4. During your last visit to our office, how would you rate your treatment by our staff?
5.How would you rate the overall quality of care you had received?
6. How would you rate the doctor on patience, warmth and interest in your care?
7. How would you rate the surgeon's explanation of the illness, treatments available or surgical procedures?
8. How would you rate the scheduling process in our office for setting up your surgery?
9. How would you rate the website?
10. Knowing what you know now, would you still choose us for your surgery and, would you recommend us to others?
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Thank you for contacting us. We will get back to you as soon as possible