Midwest NHA
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Patient Satisfaction Survey
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How did you hear about Midwest NHA?
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Physician Referral
You saw one of our physicians in the hospital
Friend/Family Member
Other
If physician referral, please specify the referring physician.
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If Other please specify:
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The registration forms were easy to understand.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The reception staff was friendly and helpful.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The waiting time was acceptable.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The medical staff was courteous and informative.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My doctor answered all my questions.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My doctor spent enough time with me.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall my experience in the clinic was a positive one.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Was there a member of our staff that was particularly helpful? If so, please tell us who.
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We would appreciate your feedback on what you liked and didn't like about our office.
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Is there anything we can do to improve our services?
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Please provide us with your name so that we may share any positive feedback with a staff member who has made your experience especially pleasant. (Optional)
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