Outpatient Clinic Post-Visit Survey
Date of Visit
Provider Seen
How would you rate your overall experience?
How satisfied are you with the provider's communication?
Did you feel your concerns were addressed?
How would you rate the clinic's cleanliness?
Would you recommend this clinic to others?
Wait Time in Clinic
Less than 15 minutes
15-30 minutes
30-60 minutes
More than 60 minutes
Additional Comments