Forms & Surveys

In order for us to continue providing the highest quality medical services, please let us know how we are doing by taking our survey here. The survey should take approximately 10 minutes to complete. We guarantee that your contact information will not be shared or sold without your permission, unless we are required to do so by law.

* Required

How satisfied were you with the speed of your visit? *

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How happy were you with the quality of medical care? *

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Cleanliness and neatness of facility? *

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Communication and instructions? *

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Likelihood of referring friends and family? *

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How convenient were the hours PromptMD is open? *

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Courtesy and professionalism of the office staff? *

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Cost of visit? *

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Keeping your personal information private *

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Your Age*
1-1818-2525-3435-4950-6465+
Your Gender*
malefemale
How many adults age 18+ reside in your household?

male 012 or more female 012 or more