We would like to hear from you about your experience at Claremore Surgeons, Inc. Please complete the following information. You may also download this form in PDF format by clicking here. Complete the downloaded form and either fax to 918-341-7338 or mail to:

Doctor's Park
1220 N. Florence Ave.
Claremore, Oklahoma 74017

Please help us provide the best service to all of our patients.

Dr. Kyle Hrdlicka welcomes you to this practice and hopes that you had a pleasant visit while in his office.

Were we successful at providing a pleasant visit?
Yes No
Why not?

Were the staff members friendly, helpful and professional?

Yes No
Why not?

Overall, were you happy with the service you received?

Strongly agree   Agree
Disagree   Strongly disagree  

Comments: positive/negative