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* 1. Registration Process:

  Excellent Good Fair Poor
Made to feel welcome on arrival
Courtesy of the person who checked you in
Ease of registration process/forms

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* 2. Which Doctor did you see?

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* 3. The Doctor:

  Excellent Good Fair Poor N/A
Listened carefully to you
Spent enough time with you
Used language you could understand
Explained results of any testing done
Explained what you wanted to know
Gave you valuable advice and treatment
Treated you with respect and compassion
Answered your questions
Addressed your pain concerns

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* 4. Which Staff Members helped you?

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* 5. The Staff

  Excellent Good Fair Poor N/A
Were professional
Were friendly
Were skillful
Made me feel comfortable
Answered my questions
Kept me informed about my visit/progress

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* 6. Facility:

  Excellent Good Fair Poor
Cleanliness of facility
Comfortable
Pleasant setting

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* 7. Would you refer Emergency Physicians Medical Center to your friends or family?

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* 8. How satisfied were you with your overall visit today?

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* 9. We respect your time. If you unfortunately had a longer than expected wait time:

  Excellent Good Fair Poor N/A
Do you feel you were kept well informed
Do you feel you were kept as comfortable as possible during your stay

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* 10. Is there anything else you would like us to know about your visit today or how we can improve?

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