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Care Station appreciates your time and effort in completing this survey. Your honest comments will help us to improve our services. This form is for the use of Care Station patients only.
Date of visit
Was this your first visit?
Did you have an appointment?
Access to Care
How many minutes did you wait in the waiting room before you were called to register?
How many minutes did you wait before being ushered to an examination room?
Please rate the service you received. Check the box that best describes your experience. Additional comments are welcome below.
Courtesy of registration person
Speed of the registration process
Length of wait time before going into an exam room
Courtesy of clinical staff
Cleanliness and comfort of exam room
Courtesy of doctor/PA
Ability of doctor/PA to answer your questions
Demonstration of care and concern by the staff for your worries
Instructions given to you for follow up care
Amount of time care provider spent with you
Concern for your privacy
Convenience of our office hours
Convenience of our office locations
Likelihood of you recommending our practice to others
Overall rating of your visit
If you would like us to respond to your evaluation, please submit a name and phone number.