What was the date of your most recent appointment to Creekside?
Was this your first visit to Creekside or are you an existing patient of the clinic?
New Patient Existing Patient
If you selected other, please specify:
How satisfied or dissatisfied were you with the ease of finding our building and clinic location?
Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied
Any comments or suggestions?
Please rate Creekside in the following areas (Poor = 1 star, Great = 5 stars)
Ability to reach a person quickly when you called the clinic
★ ★★ ★★★ ★★★★ ★★★★★
Hours we are open
★ ★★ ★★★ ★★★★ ★★★★★
Ability to make an appointment as soon as you needed to
★ ★★ ★★★ ★★★★ ★★★★★
Professionalism and friendliness of reception staff
★ ★★ ★★★ ★★★★ ★★★★★
Time in waiting room before you were taken to an exam room
★ ★★ ★★★ ★★★★ ★★★★★
Appearance and comfort of our waiting room
★ ★★ ★★★ ★★★★ ★★★★★
If you rated any of these areas 1 or 2 stars, could you please explain what we could do to improve?
Other (please specify)
Other (please specify)
How satisfied or dissatisfied were you with the medical staff’s preparation for your appointment?
Very Satisfied Somewhat Satisfied Neither satisfied or dissatisfied Somewhat Dissatisfied Very Dissatisfied
Comments or Suggestions?
How well did our medical staff answer your questions?
Extremely Well Very Well Somewhat Well Not So Well Not At All Well
Comments or Suggestions?
Did you feel that you had adequate input on your medical care according to your preferences and individual needs?
Yes No
Comments or Suggestions
How satisfied or dissatisfied were you with the amount of time Creekside spent with you addressing your needs?
Very Satisfied Somewhat Satisfied Neither satisfied or dissatisfied Somewhat Dissatisfied Very Dissatisfied
Comments or Suggestions
Overall, how would you rate the care you received from Creekside?
Excellent Very Good Good Fair Poor
Comments or Suggestions
How well did Creekside explain your follow-up care?
Extremely Well Very Well Somewhat Well Not so Well Not at all Well
Comments or Suggestions
Was the cost of your care easily understood and transparent?
Yes No
Comments or Suggestions
How satisfied or dissatisfied were you with your payment options?
Very Satisfied Somewhat Satisfied Neither satisfied or dissatisfied Somewhat Dissatisfied Very Dissatisfied
Comments or Suggestions
How satisfied or dissatisfied were you with the value of your care for your costs?
Very Satisfied Somewhat Satisfied Neither satisfied or dissatisfied Somewhat Dissatisfied Very Dissatisfied
Comments or Suggestions
How likely is it that you would recommend Creekside to a friend or family member? (Not likely = 1 star, Very likely = 5 stars}
★ ★★ ★★★ ★★★★ ★★★★★
Please tell us, what are we doing well?
Please tell us, what can we do better?
If you’d like someone to contact you, please provide your name:
If you’d like someone to contact you, please provide your phone number:
Send