subject_line
Patient Satisfaction Survey
Thank you for providing your feedback!
Date of Visit
*
+
Site
*
Administration
Hulbert Health Center
Muskogee
NeoHealth Medical Center - NSU
NeoHealth Pediatrics
Pryor Family Medical Center
Salina Family Medical Center
Tahlequah ENT
Tahlequah Extended Care Clinic
Tahlequah Family Practice
Tahlequah Health Center
Tahlequah Pediatrics
Westville Family Medical Center
Woman's Care Center
Provider
*
Please rate your experience
*
Excellent
Good
Average
Fair
Poor
Check-In Process
Excellent
Good
Average
Fair
Poor
Friendliness of Check-In Staff
Excellent
Good
Average
Fair
Poor
Facility Appearance
Excellent
Good
Average
Fair
Poor
Professionalism of Nurse
Excellent
Good
Average
Fair
Poor
Visit with Provider
Excellent
Good
Average
Fair
Poor
Overall Rating of Visit
Excellent
Good
Average
Fair
Poor
Comments
Please list any staff members you would like to recognize for outstanding service
The following three items are optional, and will be used to follow up with any concerns noted.
Your Name
Phone Number
Email Address