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* 1. Which provider did you see?

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* 2. Which location did you visit?

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* 3. How would you rate your overall experience?

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* 4. If you answered anything other than 5 above, what could we improve?

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* 5. Please rate the following factors:

  Terrible Bad Average Good Excellent
Registration process
Friendliness of front desk staff
Physician's bedside manner
Nurse's bedside manner
Cleanliness of clinic
Clarity of communication
Overall timeliness of visit

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* 6. What services did you recieve?

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* 7. Are there any other services you'd like us to offer?

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* 8. What are the top 3 things you like about Urgent Care clinics?

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* 9. How did you hear about us?

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* 10. If you would like to receive periodic health tips and updates on our clinic, please leave your preferred email address?

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