PLEASE RATE THE FOLLOWING:
Excellent
Good
Fair
Poor
Very Poor
5
4
3
2
1
A. YOUR APPOINTMENT:
1. Welcomed, as I walked in, by the receptionist. 54321
2. The check in process was efficient. 54321
3. Time spent waiting in the lobby. 54321
4. Time spent waiting in the exam room. 54321
B. OUR STAFF
1. Valued me as a customer. 54321
2. Exceeded my expectations 54321
3. Knowledgeable, skilled, and confident 54321
4. Informed me of delays. 54321
5. Maintained my modesty. 54321
C. OUR PROVIDER:
1. Listened and answered all my questions. 54321
2. Involved me with decisions regarding my health. 54321
3. Clearly explained my diagnosis and treatment plan. 54321
4. Delivered excellent bedside manner. 54321
D. OUR FACILITY:
1. Has convenient hours of operation. 54321
2. Was clean and organized. 54321
3. Is a trusted clinic in the community. 54321
4. Is in a convenient location easily found. 54321
E. YOUR OVERALL SATISFACTION:
1. Of the practice. 54321
2. The quality of your medical care. 54321
3. Overall rating of care you received 54321
HOW LIKELY WILL YOU RECOMMEND FIRST CARE TO OTHERS? DefinitelyMaybeDefinitely Not
PLEASE TELL US WHY?
IF THERE IS A WAY WE CAN IMPROVE OUR SERVICES, PLEASE TELL US ABOUT IT? HOW DID YOU HEAR ABOUT FIRST CARE? INTERNETRADIOYELLOW PAGESDRIVE BYFRIENDOTHER
