330 West 58th Street, Suite 610, New York, NY 10019 phone (212) 315 9058 / fax (212) 315 9558
http://www.doctorstevenpark.com
*
Please rate the following services by selcting the appropriate response:
Excellent
Good
Average
Fair
Unsatisfactory
Cleanliness and overall comfort of office
Our team members' demeanor and professionalism
Timeliness of the visit
Ease of scheduling your appointment
The likelihood that you'll refer another patient to us
*
How likely is it that you would recommend Dr. Park to another family member, friend, or colleague?
1
2
3
4
5
6
7
8
9
10
For your convenience, what days and times would you like to see incorporated into our schedule?
Monday
9:00 am - 11:00 am
Tuesday
11:00 am - 1:00 pm
Wednesday
1:00 pm - 3:00 pm
Thursday
3:00 pm - 5:00 pm
Friday
after 5:00 pm
Any other comments, suggestions, or observations?
Could we use your comments in our marketing endeavors? Choose one of the options below if you approve. Thank you!
I prefer not to provide my name.
My full name approved for use.
My first name and first initial of last name only.
Name
Date
By providing an email address in the box below, you'll receive two gifts in your email inbox as a token of our appreciation for providing your feedback.
Thank you!
*
Indicates Response Required