Exit this survey

1.

1. Date of Visit:

2. Care Provider / Department

3. Which BCM facility did you visit?

4. For your appointment today, was the scheduling process easy?

5. When you scheduled your appointment for today, was the scheduling agent courteous?

6. When you arrived at the front desk, were you greeted with "Welcome to Baylor College of Medicine, I can help you" or by your name?

7. Was the front desk staff courteous?

8. Did you receive adequate information in regards to delays?

9. Did the nurses/assistants introduce themselves by name?

10. Were the nurses/assistants friendly and courteous?

11. Did the nurses/assistants show concern for your problem?

12. Was the care provider friendly and courteous?

13. Did the care provider address all of your needs?

14. Was the wait time in the clinic (from appointment time to leaving) acceptable?

15. Overall, were you satisfied with the care you received?

16. Would you recommend our facility to others?

17. Tell us more about how we can improve which will help us better care for you and other BCM patients.

18. Is there anyone you would like to recognize for providing outstanding service or care?

19. Would you like someone to contact you?

20. If yes, your name:

21. Preferred method to be contacted:

22. Phone number or email:

23. Best time to contact you by phone:

Thank you for your feedback.

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