How did you discover Dr. John Kotis and The Center For Cosmetic & Reconstructive Surgery (CCRS)?

 Friend or Family Internet Dr.or Hospital referral Other

How was your experience, first contacting us at CCRS?

 Friendly and Informative Quick and Efficient Cool and Uninterested

Were you able to schedule an appointment at the time you wanted?

 Yes No

Were the staff members helpful?

 Yes No

How was your experience when you entered our office?

 Friendly and Welcoming Quick and Efficient Cool and Uninterested

Was the waiting room clean and welcoming?

 Yes No

How was the wait time during your most recent visit (this includes time in the waiting room and exam room)?

 Very Satisfied 0-5 mins Satisfied 5-15 minutes Disappointed 15+

Was the Exam Room clean and inviting?

 Yes No

Cosmetic Patient Satisfaction Survey

How was your experience with Dr. John A. Kotis, DO? Was he friendly, kind, informative?

 Friendly and Informative Friendly, Quick and Efficient Cool, Quick, Uninterested

Did the doctor answer all your questions about your condition or procedure?

 Yes No

During your visit, did you feel that the doctor gave you enough of his attention?

 Yes No

If you were scheduled for surgery, were you provided with all necessary instructions?

 Yes No

Were you informed of your financial responsibility for the procedure in an appropriate manner?

 Yes No

If you had surgery or a procedure, were you made comfortable during your experience?

 Yes No

If you had surgery, did Dr. Kotis or his staff call you in 24 hours to check on your condition?

 Yes No

If you phoned our office after hours, and reached our answering service, were you contacted in a reasonable time?

 Yes No

If you phoned with a question for the doctor or staff, how was your experience? Was your question answered?

 Yes No

Would you recommend friends and family to Dr. John Kotis at the CCRS?

 Yes No

Overall, how was your experience at the Center For Cosmetic and Reconstructive Surgery?

 Excellent Very Good Satisfactory Poor

I give Dr. John Kotis permission to use comments from the above survey, anonymously, for use on his printed material, website or other social media.
 Yes No

Patient Name:

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