• Patient's Sex*
  • Date of Visit*
     - - :
  • Time of Day you arrived at Guardian Urgent Care:*
  • Why did you Visit Guardian Urgent Care?*
  • If you answered Injury to the previous question was it work related?
  • Please rate Guardian Urgent Care in the following areas:
  • Hours of Operation*
  • Services Offered*
  • Convenience of Location*
  • Front Desk Staff was Friendly and Knowledgeable*
  • Time spent in Waiting Room*
  • Time spent in Exam Room*
  • Medical Staff was friendly and knowledgeable*
  • Physician listened to you and answered all questions*
  • Level of Treatment by the Physician*
  • Time spent waiting for Laboratory Samples*
  • Pricing for Services*
  • Charges were explained*
  • Overall Cleanliness of the Facility*
  • Overall Comfort during your visit*
  • Overall Quality of Care*
  • Would you recommend Guardian Urgent Care to Others?*
  • May we use your comments on our website, flyer, or any other publication produced by Guardian Urgent Care?
  • Should be Empty: