Patient Satisfaction Survey

Heal 360 Urgent Care

     Thank you for recently coming into Heal360 Urgent & Primary Care. We hope your visit was enjoyable and met your health care needs. We value your input and your comments will help us to improve our clinics. Please answer the following questions and make any comments you desire. Signatures are not requested and your privacy will be protected. Thank you for taking time to answer these questions and making Heal360 Urgent & Primary Care a great health care clinic.

How would you rate each of the following?
Poor - 1, Fair - 2, Good - 3, Very Good - 4, Excellent - 5

1. How long did you wait to be seen by the physician?
2. Convenience of the location of the clinic?
3. When you called our office how were you treated over the phone?
4. How were you treated by our staff?
5. How were you treated by the attending physician?
6. How interested would you be in Online Patient Check-in for Heal 360?
7. Which location did you visit today?
8. How did you hear about us? (check all that apply)
Health Care Provider
Website / Internet
Print Ad Door Hanger
Community Event
Family / Friend
Live Nearby / Drive By
Local Flavor
9. Would you visit our clinic again? Yes No
10. Would you refer us to a friend? Yes No
11. May we contact you for more input? Yes No
12. Would you use Online Patient Check-in if it were a service offered by Heal 360? Yes No

Additional Comments:

Captcha image Refresh

Write a Review