PDG Cosmetic Patient Survey
Peraza Dermatology Group continuously strives to improve the office experience for patients. Please submit feedback regarding your recent cosmetic appointment to help us better serve you and other cosmetic patients. Thank you for participating!
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Email address: Please note that in order for us to issue a $25.00 credit, we will need this field to be populated.
Who did you visit with today for your cosmetic needs? Please check all that apply. *
Required
What cosmetic procedure(s) did you have performed? Please check all that apply. *
Required
Please rate the following items on a scale of 1 to 5 (with 1 being the lowest and 5 being the highest)
Ease of making your cosmetic appointment. *
Highly Unsatisfied
Highly Satisfied
Appearance and cleanliness of treatment room and common spaces. *
Highly Unsatisfied
Highly Satisfied
Did you find the forms easy to complete? *
Highly Unsatisfied
Highly Satisfied
Wait time before your scheduled appointment time. *
Highly Unsatisfied
Highly Satisfied
Did the staff explain the treatment and make themselves available to answer your questions? *
Highly Unsatisfied
Highly Satisfied
Did our service meet your expectations? *
Highly Unsatisfied
Highly Satisfied
Are there any cosmetic treatments or services that we do not currently offer that you would like us to consider in the future?
Please provide any additional information that you think would be helpful for us to know to improve the patient experience.
Would you recommend Peraza Dermatology Group to a family or friend? *
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