Feedback is very important in any professional, personal or technical effort. 

Please copy, complete, and send these to Dr. Elder by whatever means with which you feel comfortable.   Anonymous information, though not as useful, is invited.

YES

NO

1. Are you a current patient?

2. Have you been treated respectfully?

3. Treated warmly?

Comments:

4. Do you feel confident in Dr. Elder’s knowledge?

5.  Confident in his judgment?

Comments:

6. Would you recommend Dr. Elder to your friends?

Comments:

Other comments: