Blue - Wide
Red - Desktop
Orange - Ipad
Green - Iphone
Online Consultation
Patient Forms
Appointment Scheduler
Patient Survey
(408) 356-2345
Home
Pay Now
OnLine* MD Consultation
Practice
Dermatology
Results
Contact
(408) 356-2345
Practice
Dermatology
Resources
Contact
Pay Now
OnLine* MD Consult
(408) 356-2345
Patient
Resources
– Select –
Survey
Survey
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Date of Service
*
Please rate Dr. Miller's performance as related to your medical care.
Six drop down boxes where 1 = lowest and 5 = highest.
Examined patient thoroughly.
*
1
2
3
4
5
Ability to communicate information.
*
1
2
3
4
5
Answered patient questions.
*
1
2
3
4
5
Spent time with the patient.
*
1
2
3
4
5
Provided advice / treatment with clear instructions.
*
1
2
3
4
5
Overall physician score.
*
1
2
3
4
5
Please rate the performance of Dr. Miller's practice and staff.
Six drop down boxes where 1 = lowest and 5 = highest.
Making / reminding appointments
*
1
2
3
4
5
Staff perfomance
*
1
2
3
4
5
Parking
*
1
2
3
4
5
Wait time
*
1
2
3
4
5
Communication
*
1
2
3
4
5
Overall practice score
*
1
2
3
4
5
Helpful suggestions:
Please provide specific suggestions to improve our services.
Captcha
*
I am not a Robot
Email
Submit
Patient Resources
Resources
Blog
Office Policies
Patient Registration Form
Privacy
Schedule An Appointment
Email Us
Ph. (408) 356-2345
14911 National Ave. Suite 5
Los Gatos, CA 95032
