Date of visit
  Patient Name (optional)
  Phone (optional)
  E-mail (optional)
1: The receptionist was professional, friendly and helpful.
2: The medical staff introduced themselves.
3: The medical staff was professional, friendly and helpful.
4: I was kept informed of what to expect throughout my visit.
5: The medical staff clearly explained test results and planned treatment.
6: Upon discharge I received clear instructions and my questions were answered.
7: My medical needs were met in a timely manner.
8: How would you rate our facility and accommodations?
9: How would you rate your overall WNY Immediate Care experience?
10: I would return to WNY Immediate Care.
11: If WNY Immediate Care were not available, how would you handle your medical emergency?
12: How did you hear about WNY Immediate Care? (Check all that apply.)
  Are you willing to provide a testimonial about the care you or a loved received at WNY Immediate Care for advertising purposes? If so, please write a very brief description of your experience and be sure to include your contact information above. Thank you!