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214.871.7000

Fax

214.871.7020

 

A Brief Patient Survey

 
After you've visited our Dallas urgent care facilities we want to know what you think about your experience!

Please complete these 6 questions on our form so we can continue to improve our medical services. You do not need to give us your name or contact information; all information will be kept confidential.

1.) Please indicate which services which were provided on your visit:
X-ray Laceration repair Pain treatment Asthma
Lab Allergic reactions Physicals General medicine
IV therapy Burns Fever Cold / Flu
Bone fracture Traumatic injuries Vaccines  
 
2.) What additional services could we provide that would best meet your needs for medical care?
 
3.) Please choose the hours of service that would best meet your needs for medical care; check all that apply:
8 AM - Noon Noon - 4 PM 4 PM - 8 PM 8 PM - 10 PM
 
4.) What would influence you to continue seeking your medical care at City Doc Urgent Care Center? Check all that apply.
Cost Atmosphere Quality of care Services provided
 Other:
 
5.) Please rank the quality of care you received on your visit:
Date of your visit:
Physician: 1 (poor) 2
 		 3
 		 4
 		 5
(excellent)		  
Nurse/technician: 1 (poor) 2
 		 3
 		 4
 		 5
(excellent)		  
Wait time: 1 (poor) 2
 		 3
 		 4
 		 5
(excellent)		  
 
6.) Please share any additional comments or thought that would help serve you best:
       

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