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Patient Survey

Thank you for your interest in Specialty Clinics of Georgia - Pain Management. We look forward to hearing from you soon. The facility you were treated in: Which physician treated you:

Overall how would you rate our facility?
How was the registration service?
Rate the treatment area and accommodations
Were things clean and in working order?
Were your financial arrangements satisfactory?
How do you rate the waiting time?
Were the waiting areas clean and comfortable?
Were staff members courteous, knowledgeable, and responsive to your needs?

*QUESTIONS & COMMENTS

OPTIONAL INFORMATION

If you would like, you may provide your name and contact information. Otherwise, this survey remains anonymous.

First Name	Last Name
Day Phone Number	Email Address

OFFICE PHONE NUMBER:

(770) 297-7277

FAX NUMBER:

(770) 533-7641