Overall satisfaction with the service provided *

5 - Excellent 4 - Very Good 3 - Good 2 - Satisfactory 1 - Bad

If you did not have the clinic, where would you get your care from? *

Urgent Care/Walk-in Clinic Emergency Room/Hospital Another Doctor Nowhere (would not seek care elsewhere)

Does having the clinic access make you more likely to stay with your current employer? *

Yes No

Would you encourage your co-workers to use the clinic? *

Yes No

Please indicate the status of today's visit. *

Appointment Walk-In

How long did you wait? *

No Wait Less Than 5 Minutes 5-10 Minutes 10-20 Minutes 20+ Minutes

How likely are you to come back for medical care? *

I've Already Scheduled My Next Appointment Very Likely Likely Unlikely Not At All

How did you hear about us?

Onsite event Co-worker Email blast Breakroom poster/Flyer Payroll stuffer Social Media Other

Recommendations / Comments?