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  1. Surveys
  2. 2011
  3. March
  4. C
  5. Customer Satisfaction
0%
Exit Survey »
 
 
1. How long after your scheduled appointment time did you wait to be seen?
 
0-5 Minutes
 
5-10 Minutes
 
10-15 Minutes
 
15-20 Minutes
 
Greater than 20 Minutes
 
 
 
* 2. Did you visit Medical, Dental or both?
 
Medical (skip to question #4)
 
Dental (skip to question #3)
 
Both (continue)
 
 
 
3. HOLD FOR DENTAL QUESTION
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
4. Did you have a FLY/Non-FLY/Firefighter physical completed on this visit?
 
FLY
 
Non-FLY
 
Firefighter
 
Did Not Visit (skip to question #9)
 
 
 
5. What was your total length of time spent in the clinic to complete your physical?
   
 
 
 
6. How would you rate your level of satisfaction with the Provider?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
 
Did Not Visit
 
 
 
7. How would you rate your level of satisfaction with the Medical Technician?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
 
Did Not Visit
 
 
 
* 8. How would your rate the level of professionalism of the clinic staff?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
 
 
 
9. Do you have any comments, suggestions or concerns?
   
 
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