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  2. 2005
  3. April
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Hello:

You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
What is the longest time you have waited to be seen?
 
5-mins
 
10-20mins
 
30-1hr
 
More than 1 hour
 
 
 
How Long did you have to wait to get an appointment?
1 week 2 weeks 3 weeks 1-2 months 3 months or longer
 
 

How did you find out about our services?
Friend Primary Care Physician Internet Other
 
 

Did you find our office easy to find?
Yes No
 
 

When you entered into the office where you properly greeted?
Yes No
 
 
 
* Were you satisfied with the services provided to you? If not how could they be improved?
Yes
 
 
 
Would you recommend this clinic to a friend why or why not?
   
 
 
 
Additional Comments/Suggestions for improvement
   
 
Please contact [email protected] if you have any questions regarding this survey.
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