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RediClinic Patient Survey

How well did we serve you? Please take the time to answer this quick survey and receive $10 off any screening you choose.
*Patient Name: 
*Date of Birth:   (mm/dd/yyyy)
*Contact Phone Number:   
*Clinic Location: 
*Health Care Provider: 
Note: If you don't know your clinic location or health care provider's name, please refer to your receipt.
*Is this your first time to fill out a RediClinic survey?      Yes      No
Please rate the following based on your previous visit(s) to RediClinic:
Scale: (1=poor, 3=good, 5=excellent)
  *1. Overall cleanliness  1      2      3      4      5
  *2. Hours of operation  1      2      3      4      5
  *3. Health care provider's explanation of:  
      a. screening service  1      2      3      4      5      N/A
      b. diagnosis  1      2      3      4      5      N/A
      c. method of treatment  1      2      3      4      5      N/A
  *4. Health care provider's interaction with you  1      2      3      4      5      N/A
  *5. Speed in receiving screening results  1      2      3      4      5      N/A
  *6. What was your wait time to be seen?  0-15 min     15-30 min     30+ min
  *7. What was your total time spent in clinic with the
       health care provider?  0-15 min     15-30 min     30+ min     N/A
  *8. Would you return?  Yes      No    
   9. Our customers have good ideas. Please provide us with some we should consider:
 
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Additional Comments:
 
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Note: * are required fields.