We Want to Hear from You!

Instructions: Please provide your immediate feedback about your recent visit to help us improve our services. This form is quick to complete, and your responses will remain anonymous.

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1. Choose your location seen at today. (Required.)

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2. Choose department seen at today. (Required.)

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3. Choose provider seen today. (Required.)

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4. Was our staff friendly and welcoming?

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5. Does this clinic meet your health care needs?

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6. How long did you wait in the LOBBY before being called back to an exam room?

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7. How long did you wait in the EXAM ROOM before the provider came in?

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8. What would you rate your overall visit experience (0-10)?

0 10 (Best)
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i We adjusted the number you entered based on the slider’s scale.

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9. Please list below any suggestions for how we can improve your experience.

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