Patient Satisfaction Survey

Status(Required)
Age(Required)
Gender(Required)
Race/Ethnicity(Required)
How would you rate the cleanliness of the clinic, including the lobby and exam rooms?(Required)
How would you rate the courtesy and helpfulness of the front office staff?(Required)
Through what method was your last interaction with Health Services?(Required)
How long did it take you to check in on the computer?(Required)
How long did you wait in the lobby before you were taken to an exam room?(Required)
Which of the following providers did you see or speak with during your last interaction with Health Services?(Required)
Were all of your questions/concerns answered by the provider?(Required)
How would you rate the steps taken to ensure privacy and confidentiality during your last interaction with Health Services?(Required)
Overall, how satisfied were you with your last interaction with Health Services?(Required)
This field is for validation purposes and should be left unchanged.