Please rate the following: |
Excellent |
Very Good |
Good |
Fair |
Poor |
N/A |
1. |
Overall quality of service and care received during your visit today. |
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2. |
Ability to schedule a timely appointment for a routine visit. |
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3. |
Ability to schedule a timely appointment for urgent care. |
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4. |
Wait from the time of your scheduled appointment until the time you were seen. |
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5. |
How well you were kept informed of delays, if any, during your visit. |
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6. |
Courtesy and caring of: |
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Check-in Staff |
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Check-out Clerical Staff |
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Nursing Staff |
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Doctor |
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Physician Assistant |
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Nurse Practitioner |
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7. |
Instructions and explanations given to you during your visit. |
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8. |
Cleanliness and appearance of the clinic. |
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9. |
Is there anyone you would like to recognize for doing something outstanding for you? |
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10. |
Would you recommend this clinic to a friend or family member? |
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11. |
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12. |
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13. |
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