We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

Patient Information

5 - Great, 4 - Good, 3 - OK, 2 - FAIR, 1 - POOR

Ease of getting care:

Ability to get in to be seen

  • 5
  • 4
  • 3
  • 2
  • 1

Hours Center is open

  • 5
  • 4
  • 3
  • 2
  • 1

Convenience of Center’s location

  • 5
  • 4
  • 3
  • 2
  • 1

Prompt return on calls

  • 5
  • 4
  • 3
  • 2
  • 1
Waiting:

Time in waiting room

  • 5
  • 4
  • 3
  • 2
  • 1

Time in exam room

  • 5
  • 4
  • 3
  • 2
  • 1

Waiting for tests to be performed

  • 5
  • 4
  • 3
  • 2
  • 1

Waiting for test results

  • 5
  • 4
  • 3
  • 2
  • 1
Staff:

Provider: (Physician, Dentist, Physician Assistant, Nurse Practitioner)


Listens to you

  • 5
  • 4
  • 3
  • 2
  • 1

Takes enough time with you

  • 5
  • 4
  • 3
  • 2
  • 1

Explains what you want to know

  • 5
  • 4
  • 3
  • 2
  • 1

Gives you good advice and treatment

  • 5
  • 4
  • 3
  • 2
  • 1
Nurses and Medical Assistants:

Friendly and helpful to you

  • 5
  • 4
  • 3
  • 2
  • 1

Answers your questions

  • 5
  • 4
  • 3
  • 2
  • 1
All Other:

Friendly and helpful to you

  • 5
  • 4
  • 3
  • 2
  • 1

Answers your questions

  • 5
  • 4
  • 3
  • 2
  • 1
Payment:

What you pay

  • 5
  • 4
  • 3
  • 2
  • 1

Explanation of charges

  • 5
  • 4
  • 3
  • 2
  • 1

Collection of payment/money

  • 5
  • 4
  • 3
  • 2
  • 1
Facility:

Neat and clean building

  • 5
  • 4
  • 3
  • 2
  • 1

Ease of finding where to go

  • 5
  • 4
  • 3
  • 2
  • 1

Comfort and Safety while waiting

  • 5
  • 4
  • 3
  • 2
  • 1

Privacy

  • 5
  • 4
  • 3
  • 2
  • 1
Confidentiality:

Keeping my personal information private

  • 5
  • 4
  • 3
  • 2
  • 1

The likelihood of referring your friends and relatives to us:

  • 5
  • 4
  • 3
  • 2
  • 1

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