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Patient Survey

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.
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2. The check in process was efficient.
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3. Time spent waiting in the lobby.
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4. Time spent waiting in the exam room.
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B. OUR STAFF

1. Valued me as a customer.
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2. Exceeded my expectations
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3. Knowledgeable, skilled, and confident
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4. Informed me of delays.
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5. Maintained my modesty.
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C. OUR PROVIDER:

1. Listened and answered all my questions.
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2. Involved me with decisions regarding my health.
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3. Clearly explained my diagnosis and treatment plan.
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4. Delivered excellent bedside manner.
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D. OUR FACILITY:

1. Has convenient hours of operation.
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2. Was clean and organized.
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3. Is a trusted clinic in the community.
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4. Is in a convenient location easily found.
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E. YOUR OVERALL SATISFACTION:

1. Of the practice.
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2. The quality of your medical care.
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3. Overall rating of care you received
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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?
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