1. Default Section

Did you wait longer than 20 minutes to be seen?

Question Title

* 1. Did you wait longer than 20 minutes to be seen?

Was your visit the result of a scheduled appointment?

Question Title

* 2. Was your visit the result of a scheduled appointment?

Was the Specialist professional and courteous?

Question Title

* 3. Was the Specialist professional and courteous?

If No, please briefly explain:

Question Title

* 4. If No, please briefly explain:

Did the Specialist answer your questions thoroughly?

Question Title

* 5. Did the Specialist answer your questions thoroughly?

If No, please briefly explain:

Question Title

* 6. If No, please briefly explain:

How can SHA better serve you?

Question Title

* 7. How can SHA better serve you?

Tenant Name

Question Title

* 8. Tenant Name

Specialist Name

Question Title

* 9. Specialist Name

Date of Visit

Question Title

* 10. Date of Visit

Date
Reason for visit?

Question Title

* 11. Reason for visit?

T