Q.1
At which MASH facility did you receive treatment? *

Q.2
Which provider (doctor or nurse) treated you during your visit?

Q.3
How many times have you visited MASH (or MedFirst)? *

Q.4
How did you first learn about MASH (MedFirst)? *

Q.5
Do you have a primary care physician (also known as a family doctor)? *

Q.6
On a scale of 1-10 (10 being the best), please rate the following: *

Additional Comments.

1 2 3 4 5 6 7 8 9 10 N/A
Registration Process
Total time for visit
Physician's "Bedside Manner"
Nurse's "Bedside Manner"
Cleanliness of Facility
Friendliness of Front Office Staff
Friendliness of XRay or Lab Staff
Assistance with Specialist Referral
Clarity of Communication
Overall MASH Experience

Registration Process

Total time for visit

Physician's "Bedside Manner"

Nurse's "Bedside Manner"

Cleanliness of Facility

Friendliness of Front Office Staff

Friendliness of XRay or Lab Staff

Assistance with Specialist Referral

Clarity of Communication

Overall MASH Experience

Q.7
What do you think are some of our strengths and weaknesses?

Q.8
Please select the top 3 things you favor most about MASH (MedFirst) and our centers. You may click in the check boxes to select. *

Q.9
Please use to space below to add any other comments you may have.

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