Photo Gallery
Click Here
Newsletter
Monthly Specials
Physician Information
Home  Patient Survey
Click here for
Patient Survey
Your valuable input helps us to serve you in the best possible way. This survey helps us to determine your level of satisfaction, what we are doing well and where we can improve our services to you.
Please select one answer to each of the questions below regarding your experience at JVAI.
Rating Scale: 1-Excellent 2-Very Good 3-Average 4-Fair 5-Poor 6-NA
Front Desk
1. Courtesy and professionalism of our front desk personnel?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
2. Efficiency of our patient intake process?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
3. Clarity of instructions prior to procedure?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
4. Explanation of our billing procedure with your insurance company?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
5. Explanation of your payment responsibilities?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
Office Appointments
6. Courtesy and professionalism of our ultrasound technician(s)?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
7. Courtesy and professionalism of our aesthetic technician(s)?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
8. Courtesy and professionalism of our surgical staff?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
9. Communication between staff and family member?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
10. Actual waiting times as compared with anticipated waiting times indicated by our staff?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
Facility
11. Was our waiting room comfortable?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
12. Was our aesthetic suite comfortable?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
13. Was our surgical suite comfortable?
1. Excellent 2. Very Good 3. Average 4. Fair 5. Poor 6. NA
14. What additional treatments and/or services would you be interested in receiving from JVAI?
15. Would you recommend JVAI to your family and friends? Yes   No
Additional Comments:
Patient Information
First Name:*
Last Name:
Telephone:*
Email:*
Alternate Phone:
Procedure:
Physician / Provider:
Date of Service:*
Please enter the string shown in the image in the form:*  
I would like to receive information by email from Joyce Vein & Aesthetic Institute.
View Privacy Policy

Please note: If you are getting an error message with the string code, it may be due to firewall issues. Use Internet Explorer or Firefox as your browser to avoid this problem.
  jvai.com • 25092 Olympia Avenue • Punta Gorda, FL 33950 • Call Toll Free 1(866) 998-1312
  JVAI in Punta Gorda is conveniently located in Southwest Florida close to Marco Island, Naples, Bonita Springs,
Fort Myers, Cape Coral, Sanibel Island, Port Charlotte, Lehigh Acres, Venice and Sarasota