Emergency Rooms 24

Please complete all questions, thank you!

1. Age:

2. Sex:

3. Occupation:

4. Total number of visits:

Please rate us from 1 to 5 based on the questions below.

		5 EXCELLENT	4 VERY GOOD	3 GOOD	2 FAIR	1 POOR
05. Upon arrival
a.	The efficiency of the paperwork process
b.	Waiting time in the reception area (before and after seeing the doctor)
c.	Communication of the clinical process by our staff to you
d.	Assistance/demeanour of the security team outside
06. Our staff
a.	The friendliness and courtesy of the receptionists
b.	The efficiency and professionalism of the nurses/nurse aides
c.	The professionalism of the x-ray staff
07. Expperience with the doctor
a.	Was the doctor knowledgeable
b.	Explaining things in a way you could understand
c.	The thoroughness of the examination
08. Our facility
a.	Overall comfort (cleanliness of the environment / linen)
b.	Signage and labels in the unit
09. Your overall satisfaction with:
a.	Our practice/service
10. Are you a new or returning patient?			YES		NO
11. On a scale of 1-10, how likely are you to recommend us to others?
12. Time of visit. Please indicate the time to you came in to seek treatment
13. How do you rate our COVID-19 screening process?

Thank you for taking time to go through this survey. Your candid feedback is valuable to us as we seek ways of improving our service.