Patient feedback | EmergiCare

Name:

First Name Last Name

Email Address:

Phone Number:

*Clinic:

Select clinic at which you were treated.

Patient Satisfaction Questions

On a scale of 1 to 5 (1=poor, 2=fair, 3=good, 4=very good or 5=excellent) how would you rate the following questions?

1. Was it Easy to get through to EmergiCare on the phone?

2. Was the front office person (receptionist) pleasant and courteous on the phone or in the clinic?

3. Was the back office person (MA/RT/nurse) pleasant and courteous on the phone or in the clinic?

4. Was the doctor pleasant and courteous on the phone or in the clinic?

5. Did the doctor give you enough time to discuss your needs (meds, tests, next steps)?

6. Did you have to wait long before seeing the doctor?

7. How would you rate the pleasantness and comfort of the office/exam room?

8. Did you have prompt resolution to billing concerns?

9. Would you recommend EmergiCare to your friends and family?

10. Would you recommend the doctor to your friends and family?

11. What is your overall rating of EmergiCare?

Additional Comments

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