We Strive for Five!
Please take a moment to complete our patient feedback form. Or if you prefer, call our customer service feedback line at 404-872-4138 and leave a voice mail. We would like to know how your last visit went, and if there is anything we could do to improve future visits for you and/or other patients. Our philosophy is simple - We Strive For Five! If we do not score a Five on any question, then we have failed.
Full Name
Name of Obstetrician
Email

Date of birth?
Date of visit?
Overall satisfaction with vist?





Satisfaction with front office staff?





Satisfaction with sonographer?






Satisfaction with provider (physician or midlevel)?






Satisfaction with billing personnel?






Were you seen in a timely manner?





Which office did you visit?
What can we do to improve?
Do you have any other comments?