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Patient Satisfaction Survey
We strive to provide you with the finest medical care. Please take a few minutes to complete this questionnaire evaluating our center, physicians, and staff.
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HIPAA
Compliance
1
I was greeted when I entered the facility.
TRUE
FALSE
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2
Was this your first procedure in an outpatient facility? (Non-hospital).
TRUE
FALSE
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3
The check-in process ran smoothly.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Satisfied
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4
My wait time was reasonable and I received notification of any delay.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
1
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5
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Very Satisfied
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5
The front desk staff was courteous and efficient.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Satisfied
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6
The staff was concerned about my comfort.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Satisfied
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7
The clinical staff was courteous and efficient.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
1
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Very Unsatisfied
Very Satisfied
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8
My doctor was courteous and listened to my concerns.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
1
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Very Unsatisfied
Very Satisfied
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9
Who was your doctor?
Please select your physician from the following list:
Dr. Adlakha
Dr. Quintana
Dr. Rizk
Dr. Subedi
Dr. Tasan
Dr. Zayed
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10
My privacy was maintained throughout my visit.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Unsatisfied
Very Satisfied
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11
I received adequate information about my discharge care.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Unsatisfied
Very Satisfied
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12
I felt safe in the facility.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
1
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Very Satisfied
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13
The facility was clean and well-maintained.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Satisfied
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14
I would recommend this facility to a friend.
Please add a star rating to indicate how you feel about the statement above with 5 Stars indicating Very Satisfied and 1 Star indicating Very Unsatisfied.
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Very Unsatisfied
Very Satisfied
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15
Would you like to provide your name?
You do not need to provide your name if you wish to remain anonymous
YES
NO
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16
Please enter your name below:
First Name
Last Name
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17
Would you like to be contacted regarding your experience?
This is optional, please select if you want a member of our administrative staff to reach out regarding your experience.
YES
NO
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18
Please enter your phone number
Only provide the phone number if you wish to be contacted regarding your visit
Please enter a valid phone number.
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19
Is there any additional information you would like to provide about your experience?
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