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General Information
What was the reason for your recent visit to our healthcare facility?
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Routine check-up
Illness/Injury
Chronic Condition Management
Specialist Referral
Other
How did you hear about our healthcare facility?
From a friend or family member
Referral from another healthcare provider
Online Search
Social Media
Other
Quality of Care
How satisfied are you with the quality of care you received during your recent visit?
Did you feel like your healthcare provider listened to your concerns and addressed your needs during your visit?
Yes
No
How satisfied are you with the communication from your healthcare provider?
Did you feel like your healthcare provider explained your medical condition and treatment plan clearly and in a way that you could understand?
Yes
No
Facility and Staff
How satisfied are you with the cleanliness and comfort of our healthcare facility?
Did you find our front desk staff to be friendly and helpful?
Yes
No
How satisfied are you with the friendliness and professionalism of our healthcare providers and staff?
How likely are you to recommend our healthcare facility to your family and friends?
0
1
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10
How likely will you return to our healthcare facility for future medical care?
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Do you have any additional comments or suggestions for improving our facility and the care we provide?
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