Follow Up Questionnaire

We would love to hear from you and learn how we can be a better team for you. Please answer the questions below to help us in this quest to further our Mission Statement. Our Mission is to provide unwavering quality care to improve people's lives through Facial Plastic Surgery and the YoungVitalizer. You can also email us at contactusatdrphilipyoung.com. In the form below you have an option to leave your name, email and phone number as you wish. This is not a requirement to submit the Quality Care Questionnaire.

First Name* This field is required.

Last Name* This field is required.

Phone* This field is required.

Email* This field is required.

1. What areas of your body were you dissatisfied with and wanted to improve?

2. How long have you had this dissatisfaction?

3. What procedures were you interested in?

4. Why did you decide to choose Dr. Young and our office for the procedures that you had rather than some other plastic surgeon?

5. What specific value or benefit do you feel you received from this procedure?

6. How can we improve what we have done for you in the future?

7. Who do you feel or what particular person do you think would most benefit from the type of procedure / service that you had with us?

8. Is there anything special that you have experienced from your procedure that you did not expect before deciding to have it done?

9. What is your sex? What is your age?

10. What is your household income?

11. What newspapers do you read?

12. What websites do you browse most often?

13. What radio stations do you listen to?

14. What TV shows do you watch?

15. What magazines do you read?

16. What type of events, shows, activities do you normally participate in?

17. What type of work do you do?

18. What are your hobbies? Where do you work out? What do you like about those things?

19. Do you have your own website?

20. Who did you consider other than us as one of your top choices in a facial plastic surgeon?

21. Where would you expect us to be in terms of magazine, TV, radio, websites / online, newspapers, events?

22. Do you have any other comments for us to consider?

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By completing this form, you are giving us permission to follow-up by phone, email or text.

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Follow Up Questionnaire

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