Patient Feedback

- Step 1 of 10

Thank you for participating in our patient survey! Your feedback and suggestions will help us to better understand how we can continue to improve our services.

Your information is kept private and is completely anonymous. After submitting your survey, you'll have the option to opt-in to our drawing, where you could be the lucky winner of a free Dermaplane and Deluxe HydraFacial at Carilion Clinic Cosmetic Center.

Age *

Sex *

Zip Code *

How long have you been a patient? *

How did you hear about us? *

Tell us more about how you heard about us... *

When do you plan on scheduling your first visit? *

Your Location *

What brought you to us for your first visit? *

When thinking about how we communicate with you, how satisfied are you with the following? *

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Awareness about sales	Awareness about sales Very Unsatisfied	Awareness about sales Unsatisfied	Awareness about sales Neutral	Awareness about sales Satisfied	Awareness about sales Very Satisfied
Frequency of our specials	Frequency of our specials Very Unsatisfied	Frequency of our specials Unsatisfied	Frequency of our specials Neutral	Frequency of our specials Satisfied	Frequency of our specials Very Satisfied
Explanations of product benefits	Explanations of product benefits Very Unsatisfied	Explanations of product benefits Unsatisfied	Explanations of product benefits Neutral	Explanations of product benefits Satisfied	Explanations of product benefits Very Satisfied
Ease of scheduling an appointment	Ease of scheduling an appointment Very Unsatisfied	Ease of scheduling an appointment Unsatisfied	Ease of scheduling an appointment Neutral	Ease of scheduling an appointment Satisfied	Ease of scheduling an appointment Very Satisfied

Any additional comments about how we communicate with you? (optional)

Have you visited any of our locations? *

Roanoke
Blacksburg
Both
None

Have you heard about our Open House events throughout the year? *

Our Open House events give you the chance to stop by the office, meet our staff, see demonstrations, and take advantage of discounts and sales.

When thinking about your time in our clinic, how satisfied are you with the following? *

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Comfortable Furniture	Comfortable Furniture Very Unsatisfied	Comfortable Furniture Unsatisfied	Comfortable Furniture Neutral	Comfortable Furniture Satisfied	Comfortable Furniture Very Satisfied
Office lighting	Office lighting Very Unsatisfied	Office lighting Unsatisfied	Office lighting Neutral	Office lighting Satisfied	Office lighting Very Satisfied
Parking availability	Parking availability Very Unsatisfied	Parking availability Unsatisfied	Parking availability Neutral	Parking availability Satisfied	Parking availability Very Satisfied
Wait time to be seen	Wait time to be seen Very Unsatisfied	Wait time to be seen Unsatisfied	Wait time to be seen Neutral	Wait time to be seen Satisfied	Wait time to be seen Very Satisfied
Ease of checkout	Ease of checkout Very Unsatisfied	Ease of checkout Unsatisfied	Ease of checkout Neutral	Ease of checkout Satisfied	Ease of checkout Very Satisfied

Any additional comments about your time in our clinic? (optional)

When thinking about your experiences with our staff, how satisfied are you with the following? *

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Professionalism	Professionalism Very Unsatisfied	Professionalism Unsatisfied	Professionalism Neutral	Professionalism Satisfied	Professionalism Very Satisfied
Friendliness	Friendliness Very Unsatisfied	Friendliness Unsatisfied	Friendliness Neutral	Friendliness Satisfied	Friendliness Very Satisfied
Helpfulness	Helpfulness Very Unsatisfied	Helpfulness Unsatisfied	Helpfulness Neutral	Helpfulness Satisfied	Helpfulness Very Satisfied
Attentiveness	Attentiveness Very Unsatisfied	Attentiveness Unsatisfied	Attentiveness Neutral	Attentiveness Satisfied	Attentiveness Very Satisfied
Knowledge about products and services	Knowledge about products and services Very Unsatisfied	Knowledge about products and services Unsatisfied	Knowledge about products and services Neutral	Knowledge about products and services Satisfied	Knowledge about products and services Very Satisfied

Any additional comments about your experiences with our staff? (optional)

Please rate your awareness of the following products and services *

	Never heard of it	Aware, but haven't used	Use it sometimes	Use it regularly
HydraFacial	HydraFacial Never heard of it	HydraFacial Aware, but haven't used	HydraFacial Use it sometimes	HydraFacial Use it regularly
Botox	Botox Never heard of it	Botox Aware, but haven't used	Botox Use it sometimes	Botox Use it regularly
Juvéderm	Juvéderm Never heard of it	Juvéderm Aware, but haven't used	Juvéderm Use it sometimes	Juvéderm Use it regularly
Dermaplane	Dermaplane Never heard of it	Dermaplane Aware, but haven't used	Dermaplane Use it sometimes	Dermaplane Use it regularly
Laser treatments	Laser treatments Never heard of it	Laser treatments Aware, but haven't used	Laser treatments Use it sometimes	Laser treatments Use it regularly
Facials	Facials Never heard of it	Facials Aware, but haven't used	Facials Use it sometimes	Facials Use it regularly
Skin care line	Skin care line Never heard of it	Skin care line Aware, but haven't used	Skin care line Use it sometimes	Skin care line Use it regularly

Any additional comments about our products? (optional)

Please rate your interest in the following surgical procedures *

	Never heard of it	Need more info	Not interested	Interested	I've had this procedure
Arm Lift	Arm Lift Never heard of it	Arm Lift Need more info	Arm Lift Not interested	Arm Lift Interested	Arm Lift I've had this procedure
Blepharoplasty (Eye Lift)	Blepharoplasty (Eye Lift) Never heard of it	Blepharoplasty (Eye Lift) Need more info	Blepharoplasty (Eye Lift) Not interested	Blepharoplasty (Eye Lift) Interested	Blepharoplasty (Eye Lift) I've had this procedure
Breast Augmentation	Breast Augmentation Never heard of it	Breast Augmentation Need more info	Breast Augmentation Not interested	Breast Augmentation Interested	Breast Augmentation I've had this procedure
Breast Lift (Mastopexy)	Breast Lift (Mastopexy) Never heard of it	Breast Lift (Mastopexy) Need more info	Breast Lift (Mastopexy) Not interested	Breast Lift (Mastopexy) Interested	Breast Lift (Mastopexy) I've had this procedure
Breast Reduction	Breast Reduction Never heard of it	Breast Reduction Need more info	Breast Reduction Not interested	Breast Reduction Interested	Breast Reduction I've had this procedure
Brow Lift	Brow Lift Never heard of it	Brow Lift Need more info	Brow Lift Not interested	Brow Lift Interested	Brow Lift I've had this procedure
Facial Rejuvenation	Facial Rejuvenation Never heard of it	Facial Rejuvenation Need more info	Facial Rejuvenation Not interested	Facial Rejuvenation Interested	Facial Rejuvenation I've had this procedure
Fat Grafting	Fat Grafting Never heard of it	Fat Grafting Need more info	Fat Grafting Not interested	Fat Grafting Interested	Fat Grafting I've had this procedure
Gynecomastia (Male Breast Reduction)	Gynecomastia (Male Breast Reduction) Never heard of it	Gynecomastia (Male Breast Reduction) Need more info	Gynecomastia (Male Breast Reduction) Not interested	Gynecomastia (Male Breast Reduction) Interested	Gynecomastia (Male Breast Reduction) I've had this procedure
Liposuction	Liposuction Never heard of it	Liposuction Need more info	Liposuction Not interested	Liposuction Interested	Liposuction I've had this procedure
Neck Lift	Neck Lift Never heard of it	Neck Lift Need more info	Neck Lift Not interested	Neck Lift Interested	Neck Lift I've had this procedure
Otoplasty (Ear Pinning)	Otoplasty (Ear Pinning) Never heard of it	Otoplasty (Ear Pinning) Need more info	Otoplasty (Ear Pinning) Not interested	Otoplasty (Ear Pinning) Interested	Otoplasty (Ear Pinning) I've had this procedure
Rhinoplasty (Nose)	Rhinoplasty (Nose) Never heard of it	Rhinoplasty (Nose) Need more info	Rhinoplasty (Nose) Not interested	Rhinoplasty (Nose) Interested	Rhinoplasty (Nose) I've had this procedure
Rhytidectomy (Face Lift)	Rhytidectomy (Face Lift) Never heard of it	Rhytidectomy (Face Lift) Need more info	Rhytidectomy (Face Lift) Not interested	Rhytidectomy (Face Lift) Interested	Rhytidectomy (Face Lift) I've had this procedure
Tummy Tuck	Tummy Tuck Never heard of it	Tummy Tuck Need more info	Tummy Tuck Not interested	Tummy Tuck Interested	Tummy Tuck I've had this procedure
Thigh Lift	Thigh Lift Never heard of it	Thigh Lift Need more info	Thigh Lift Not interested	Thigh Lift Interested	Thigh Lift I've had this procedure

Please rate your interest in the following esthetic procedures *

	Never heard of it	Need more info	Not interested	Interested	I've had this procedure
Brow shaping and tinting	Brow shaping and tinting Never heard of it	Brow shaping and tinting Need more info	Brow shaping and tinting Not interested	Brow shaping and tinting Interested	Brow shaping and tinting I've had this procedure
Chemical peels	Chemical peels Never heard of it	Chemical peels Need more info	Chemical peels Not interested	Chemical peels Interested	Chemical peels I've had this procedure
Facial brightening	Facial brightening Never heard of it	Facial brightening Need more info	Facial brightening Not interested	Facial brightening Interested	Facial brightening I've had this procedure
Deep exfoliation	Deep exfoliation Never heard of it	Deep exfoliation Need more info	Deep exfoliation Not interested	Deep exfoliation Interested	Deep exfoliation I've had this procedure
Essential facial hydration	Essential facial hydration Never heard of it	Essential facial hydration Need more info	Essential facial hydration Not interested	Essential facial hydration Interested	Essential facial hydration I've had this procedure
Laser scar reduction	Laser scar reduction Never heard of it	Laser scar reduction Need more info	Laser scar reduction Not interested	Laser scar reduction Interested	Laser scar reduction I've had this procedure
Laser hair reduction	Laser hair reduction Never heard of it	Laser hair reduction Need more info	Laser hair reduction Not interested	Laser hair reduction Interested	Laser hair reduction I've had this procedure
Cynosure Fraxel Laser Ablative/Non-ablative	Cynosure Fraxel Laser Ablative/Non-ablative Never heard of it	Cynosure Fraxel Laser Ablative/Non-ablative Need more info	Cynosure Fraxel Laser Ablative/Non-ablative Not interested	Cynosure Fraxel Laser Ablative/Non-ablative Interested	Cynosure Fraxel Laser Ablative/Non-ablative I've had this procedure
Dermaplaning	Dermaplaning Never heard of it	Dermaplaning Need more info	Dermaplaning Not interested	Dermaplaning Interested	Dermaplaning I've had this procedure
Microdermabrasion	Microdermabrasion Never heard of it	Microdermabrasion Need more info	Microdermabrasion Not interested	Microdermabrasion Interested	Microdermabrasion I've had this procedure

Please indicate how important the following is to you *

	Not at all important	Somewhat important	Very important
Specials and discounts	Specials and discounts Not at all important	Specials and discounts Somewhat important	Specials and discounts Very important
Extended hours (Open after 5pm and on weekends)	Extended hours (Open after 5pm and on weekends) Not at all important	Extended hours (Open after 5pm and on weekends) Somewhat important	Extended hours (Open after 5pm and on weekends) Very important
Having a personal cosmetic consultant/confidant	Having a personal cosmetic consultant/confidant Not at all important	Having a personal cosmetic consultant/confidant Somewhat important	Having a personal cosmetic consultant/confidant Very important
Educational Seminars	Educational Seminars Not at all important	Educational Seminars Somewhat important	Educational Seminars Very important
Live demonstrations	Live demonstrations Not at all important	Live demonstrations Somewhat important	Live demonstrations Very important
Members' only events and perks	Members' only events and perks Not at all important	Members' only events and perks Somewhat important	Members' only events and perks Very important
Referral Program to earn discounts	Referral Program to earn discounts Not at all important	Referral Program to earn discounts Somewhat important	Referral Program to earn discounts Very important

Overall, how would you rate your experience with Carilion Clinic Cosmetic Center? *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

We're sorry to hear that. How can we improve? *

What do you like most about going to Carilion Clinic Cosmetic Center? *

Do you have any other comments you would like to share? Please don't add any personally identifying information.

Please don't include names, email addresses, phone numbers, or other personally identifiable information about yourself or other patients. This survey is meant to be anonymous.

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