Thank you for visiting After Hours Pediatrics Urgent Care.

Please take a few minutes to tell us about your experience at our clinic.  Your feedback is a powerful tool that allows us to improve our patient services.

* 1. Location Visited

* 2. Date of Visit

Date
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* 3. Physician/PA/Nurse/MA

* 4. Receptionist

* 5. Contact info (optional)

* 6. The receptionist was professional, friendly and helpful.

* 7. The medical staff introduced themselves and were professional, friendly and helpful.

* 8. The medical staff clearly explained test results, planned treatment and discharge instructions.

* 9. How would you rate your overall experience at After Hours Pediatrics Urgent Care?

* 10. I would return to After Hours Pediatrics Urgent Care.

* 11. How likely are you to recommend After Hours Pediatrics Urgent Care to a friend?

* 12. Comments

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