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PATIENT SURVEY FOR NORTHSIDE URGENT CARE
 
At Northside Urgent Care & Family Medicine, our goal is to provide comfort, convenience, and satisfaction as well as the very best medical care to our patients. We'd like to know how you feel about our medical services, including our patient-handling systems, physician and staff members. Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs. Thank you for your help.

Please select the most appropriate response

Your Appointment:
Appointment available within a reasonable amount of time
Very Satisfied
 Somewhat Satisfied
 Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Appointment scheduled at a convenient time a day
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Waiting time in the reception area
Very Satisfied
 Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Waiting time in the exam room
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 

Our Staff:
The friendliness and courtesy of our receptionist
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The caring concern and professionalism of our technologist
Very Satisfied
Somewhat Satisfied
 Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 

Our Communication with you:
Your phone calls answered promptly
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Explanation of your procedure
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Your test results reported to your physician in a reasonable amount of time
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Effectiveness of our health information materials
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 

Your visit with the Doctor:
The doctor adequately explained the procedure
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The doctor took time to answer your questions
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The thoroughness of the examination
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The amount of time the doctor spent with you
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 

Our Facility:
Hours of operation convenient with you
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
 		Very Dissatisfied
 Not Applicable
Overall comfort
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Adequate parking
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Signage and directions easy to follow
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Cleanliness of facility
Very Satisfied
 Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 

Your overall satisfaction with:

Our practice
Very Satisfied
 Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied Not Applicable
The quality of your medical care
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
 
Would you recommend our practice to a family member or friend?
Yes
No
If no, please tell us why:
Would you return to our practice?
Yes
No
If no, please tell us why:
Northside Urgent Care and Family Medicine has a board certified Family Practitioner and General Internist on staff to serve your primary needs. Would you consider using our facility as your primary care physician?
Yes
No
If no, please tell us why:
 
Who is your insurance carrier?
 
Do you have one or more suggestions to improve your experience with our facility?
 
How did you hear about us?
 
Which site did you visit?
 

Demographic Information (Optional)
Female Male
 
Your Age:
 
Name (optional)
 

 
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