Quick Care

Patient Satisfaction Survey

Thank you for choosing WK Quick Care! We strive to provide the best patient care possible. We hope you had a great experience at our clinic. If you have a suggestion on how we can improve our service or a positive word to share, we’d like to hear from you. Please complete the following information selecting the most appropriate answer based on your most recent visit.

Date of Visit:
Open the calendar popup.
Location:
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Overall opinion of your visit:
Respect shown for your privacy:
Timeliness of your visit:
Professionalism of our staff:
Cleanliness of our facility:
Will you return to our facility in the future?
Please share any comments about exceptional care or areas that need improvement. (Optional):
Would you like someone to contact you about your experience?

About You (Optional):

Your Name:
Patient's Name:
Phone Number:
E-mail Address:
 

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