Dear Valued Patient:

Thank you for your recent visit to Advanced Dermatology Associates.

In our ongoing effort to provide the highest quality care to our patients, we would like you to take a moment to fill out this confidential questionnaire.   Thank you in advance for your assistance.





Initial Contact: Agree Disagree N/A
My call was answered promptly:
I was able to make an appointment at a time convenient to my schedule:
Any questions I had were answered:
I was treated with respect and courtesy:
In the office:
Which office did you visit? CPS 149th St Coop
The reception area was clean and organized:
Upon check-in, I was treated with respect and courtesy by the receptionist:
I was seen by the medical provider within a reasonable amount of time:
The provider took the time to listen to my problems and concerns:
The provider explained what he or she was doing and why:
I felt the provider was knowledgeable
Upon checkout, I was treated with respect and courtesy by the receptionist:
I was given a receipt for any payments:
I was given a follow-up appointment:
Overall Impressions:
I was pleased with how I was treated by the receptionist:
I was pleased with how I was treated by the medical provider:
My problem was taken care of:
I would come back to Advanced Dermatology Associates for my future dermatology needs:
I would recommend Advanced Dermatology Associates to my friends and family:
What did you like most about your visit to our office ?


Did any staff stand out? Yes No
If Yes, Who? 
What did you like least about your visit to our office?


Was there any aspect of your visit that could be improved ? Yes No
If Yes, please explain:
Name (Optional): 
  (Thank you!)




Day, Evening & Weekend Appointments Available.
All HMO's, PPO's, Insurance & Union Plans, Medicare & Medicaid Accepted.
ATM, American Express, Visa, MasterCard, Discover
200 Central Park South Suite 107, New York, NY 10019-1449 | Phone: (212) 262-2500
Copyright ©2014 Advanced Dermatology Associates, all rights reserved.