Satisfaction Survey

1. Tell us about your visit

Please take a few minutes to complete this survey on the quality of service we provide. We welcome your feedback and appreciate your honesty. (All Submissions are Anonymous)

1. Please Rate our Staff

	Poor	Below Average	Average	Good	Excellent
Courteous/Friendly front desk staff at check-in	*Please Rate our Staff Courteous/Friendly front desk staff at check-in Poor	Courteous/Friendly front desk staff at check-in Below Average	Courteous/Friendly front desk staff at check-in Average	Courteous/Friendly front desk staff at check-in Good	Courteous/Friendly front desk staff at check-in Excellent
Caring/Concern of the clinical staff	Caring/Concern of the clinical staff Poor	Caring/Concern of the clinical staff Below Average	Caring/Concern of the clinical staff Average	Caring/Concern of the clinical staff Good	Caring/Concern of the clinical staff Excellent

2. Please Rate your Visit

	Poor	Below Average	Average	Good	Excellent
Willingness to listen	*Please Rate your Visit Willingness to listen Poor	Willingness to listen Below Average	Willingness to listen Average	Willingness to listen Good	Willingness to listen Excellent
Taking time to answer your questions	Taking time to answer your questions Poor	Taking time to answer your questions Below Average	Taking time to answer your questions Average	Taking time to answer your questions Good	Taking time to answer your questions Excellent
Explaining things in a way you could understand	Explaining things in a way you could understand Poor	Explaining things in a way you could understand Below Average	Explaining things in a way you could understand Average	Explaining things in a way you could understand Good	Explaining things in a way you could understand Excellent
Thoroughness of exam	Thoroughness of exam Poor	Thoroughness of exam Below Average	Thoroughness of exam Average	Thoroughness of exam Good	Thoroughness of exam Excellent

3. Please Rate our Facility

	Poor	Below Average	Average	Good	Excellent
Convenient hours of operation	*Please Rate our Facility Convenient hours of operation Poor	Convenient hours of operation Below Average	Convenient hours of operation Average	Convenient hours of operation Good	Convenient hours of operation Excellent
Overall comfort	Overall comfort Poor	Overall comfort Below Average	Overall comfort Average	Overall comfort Good	Overall comfort Excellent
Cleanliness of office	Cleanliness of office Poor	Cleanliness of office Below Average	Cleanliness of office Average	Cleanliness of office Good	Cleanliness of office Excellent
Overall Satisfaction with our office	Overall Satisfaction with our office Poor	Overall Satisfaction with our office Below Average	Overall Satisfaction with our office Average	Overall Satisfaction with our office Good	Overall Satisfaction with our office Excellent
The Quality of Medical care	The Quality of Medical care Poor	The Quality of Medical care Below Average	The Quality of Medical care Average	The Quality of Medical care Good	The Quality of Medical care Excellent

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4. Which Facility did you visit?

Which Facility did you visit? Urgent Care-Cypress in Winter Haven,Fl

Urgent Care-Poinciana in Kissimmee,Fl

Workmed Davenport,Fl

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5. Would you Recommend this facility?

Would you Recommend this facility? Yes

6. Comments:

Comments:

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