EmergiCare Urgent Care
4 Convenient Locations To Serve You

Patient Feedback

We want to hear from you!

EmergiCare strives for outstanding customer service in everything we do. To help us be the best we can be, please take a moment to answer 11 quick questions about your recent experience at one of our clinics. Your responses will be held in strict confidence and will be used to help us better ourselves and our systems. Thank you for taking the time to give us your feedback.

EmergiCare Patient Satisfaction Survey

Please fill out form below and click the submit button. *Required fields.

First Name: *

Last Name: *

Email: *

Phone:

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?

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

8. Did you have prompt resolution to billing concerns?

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

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

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

11. What is your overall rating of EmergiCare?

 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent NA

Additional Comments

Emergi-Care Clinics
Emergi-Care Clinics
4 Convenient Locations To Serve You
(719) 594-0046

We want to get you seen in a timely manner, but please note that when you arrive, you will have additional paperwork to complete.