Patient Opinion Survey

 
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1. Which clinic did you visit?
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2. Date of visit
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Please enter a valid date
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3. Date of Birth
MM DD YYYY
Please enter a valid date
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4. Clinic & Staff
Strongly disagreeSomewhat disagreeNeutralSomewhat agreeStrongly agree
The lobby was clean and comfortable
The exam room was clean and comfortable
My wait time was within my expectations (If not, please indicate how long you waited in the comment section below)
The person at the front desk greeted me and helped me in a friendly manner
The clinic staff was polite, friendly and respectful of my needs
5. My Care
Strongly DisagreeSomewhat DisagreeNeutralSomewhat AgreeStrongly AgreeN/A
The physician who treated me was courteous and respectful
Tests and procedures were explained to help me understand my care
My questions were fully answered
My pain issues were adequately addressed
Follow up instructions were clear
6. Overall Impression
Extremely UnlikelyNeutralExtremely Likely
How likely is it that you would recommend Alliance Urgent Care to a family member, friend or colleague?
7. What could we have done to make your experience better? What did we do well?
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