Paul D. Brooks, DPM, P.A.

Medicine and Surgery of the Foot and Ankle

Paul D. Brooks, DPM, P.A.
9290 Baldridge Rd
Pensacola, FL 32514
ph: 850-479-6250
fax: 850-479-6247
alt: 866-242-5983
info@feetareneat.com

Home
Services
About Us
News
Laser Treatment
EPAT
Forms
Privacy Practice
Video Gallery
Job Openings
Survey
Contact Us

Survey

Monthly Prize Drawing

All patients who submit this form will be entered to win a monthly drawing for a prize. Winners will be notified via email or mail. Drawings will be held on the 5th of each month from the entries received from the previous month.

Congratulations to our Winners!!

Mar - Vincent Pettey

Feb - Richard Jacobs

Tell Us What You Think

Please fill out this short survey, so that we can make your patient experience better.

*First Name:

*Last Name:

Email:

For questions requesting a rating, use the scale of 1-10 with 10 being the best and 1 being the worst.

*How would you rate our front office receptionist?

10 9 8 7 6 5 4 3 2 1

*Are your phone calls handled in a prompt and courteous manner?

Yes No

*How would you rate your check-out experience?

10 9 8 7 6 5 4 3 2 1

*How would you rate our medical assistants?

10 9 8 7 6 5 4 3 2 1

*Please choose the Medical Assistant that helped you.

Deidre Pat Tracy Unsure

*Do you feel our medical assistants are sympathetic to your condition?

Yes No

*How would you rate the doctor.

10 9 8 7 6 5 4 3 2 1

*Did the doctor spend enough time with you?

Yes No

*Did the doctor answer all your questions?

Yes No

*Was your wait too long in the reception area before you were called?

Yes No

*Were you able to get an appointment as soon as you would have liked?

Yes No

*What was the reason for your appointment today?

Ankle Pain or Strain Bunion EPAT Fracture Heel Pain Ingrown Toenail Laser procedure Nail or callous care Neuroma Office Surgery Orthotics Plantar Wart Post-Op Surgical Consult Wound Care Other

*Would you feel comfortable referring a patient to our clinic?

Yes No

*Please rate your overall experience.

10 9 8 7 6 5 4 3 2 1

Please give us any additional comments you feel would benefit us.

Submit Your Message:

Thank you for your valuable input!

Web Hosting by Yahoo!

Paul D. Brooks, DPM, P.A.
9290 Baldridge Rd
Pensacola, FL 32514
ph: 850-479-6250
fax: 850-479-6247
alt: 866-242-5983
info@feetareneat.com