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Patient Information

Patient Satisfaction Survey

Your feedback helps us improve care at First Circle Medical Center. It takes about two minutes.

Download Printable Version

Visit Date

Provider Seen

1How easy was it to schedule this appointment?

Very Easy

Easy

Difficult

Very Difficult

2How long did you wait to be seen?

On time

Under 15 min

15-30 min

Over 30 min

3How would you rate the courtesy and respect shown by our front desk staff?

Excellent

Good

Fair

Poor

4How would you rate the courtesy and respect shown by your provider?

Excellent

Good

Fair

Poor

5Did your provider explain things in a way you could understand?

Yes

Somewhat

No

6How likely are you to recommend First Circle Medical Center to a friend or family member?

Very Likely

Likely

Unlikely

Very Unlikely

7Is there anything we could have done better today?

8Additional comments

Prefer to fill this out on paper?

Ask our front desk team for a printed copy at your next visit, or download the printable version above.

Call 954-663-2255 Back to Patient Info