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  1. Surveys
  2. 2015
  3. March
  4. E
  5. Evans-Blount Community Health Center
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Exit Survey
 
 
Welcome to our practice. You are very important to us, and we value your opinions and comments regarding our medical office. A moment of your time is requested to answer the following questions about your visit today and return it in the box located at the check out window or mail it back to us. Your comments will assist us in continuing to provide the highest quality of medical care available.


Please answer the questions using this scale
 1 (Poor)   2(Fair)  3 (Good)  4 (Very Good)  5 (Excellent)
 
 
 
Staff were helpful/professional
 
1
 
2
 
3
 
4
 
5
 
 
 
Staff were respectful
 
1
 
2
 
3
 
4
 
5
 
 
 
Staff provided information that was helpful/easy to understand
 
1
 
2
 
3
 
4
 
5
 
 
 
The services was provided in a timely manner
 
1
 
2
 
3
 
4
 
5
 
 
 
Are you satisfied with your service today
 
1
 
2
 
3
 
4
 
5
 
 
 
Were you satisfied with the hours of service?
 
Yes
 
No
 
 
 
What did you like about your service?
 
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How can we improve services?
 
 
Evans Blount
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