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Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. Of the surveys we receive, those that include contact information will be entered in our weekly drawing for two $10 movie certificates. All responses will be kept confidential. Thank you for your time.

Ease of Getting Care
  1. Great=5 Good=4 Ok=3 Fair=2 Poor=1
  2. Ability to get in to be seen
  4. Hours Center is open
  6. Convenience of Center's location
  8. Prompt return on calls
Waiting
  1. Time in Waiting room
  3. Time in Exam room
  5. Waiting for tests to be performed
  7. Waiting for test results
Staff
  1. Provider: (Physician, Physician Assistant)
  2. Takes enough time with you
  4. Listens to you
  6. Explains what you want to know
  8. Gives you good advice and treatment
  10. Did the medical staff perform adequate hand hygiene
  12. Did the medical staff wear gloves when drawing blood
  14. Did the medical staff wear gloves when giving injections
  16. Did the medical staff wear gloves when performing a procedure
  18. Paramedics and Medical Assistants:
  19. Friendly and helpfulness to you
  21. Answers your questions
  23. All Others:
  24. Friendly and helpfulness to you
  26. Answers your questions
Payment
  1. What you pay
  3. Explanation of charges
  5. Collection of payment/money
Check Out
  1. The discharge instructions were clear and understandable
  3. If you were referred to another provider was adequate information provided
Facility
  1. Neat and clean building
  3. Ease of finding where to go
  5. Comfort and Safety while waiting
  7. Privacy
Confidentiality
  1. Keeping my personal information private
Overall
  1. What is the likelihood of referring your friends and relatives to us:
  3. Do you consider this your regular source of urgent care?
  5. (required)
  6. (required)
  8. (required)
Optional Contact
  1. At Atlantis Urgent Care, we value your opinion. Please fill out the information below to be entered into our weekly drawing for two $10 movie certificates. Surveys are kept confidential.
  2. (required)
  3. (valid email required)
  4. (required)
 

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