EmailMeForm
San Luis Walk-In Clinic, Inc. Patient Survey
Provider
Please select
Dr. Bhatt
Dr. Calabrese
Dr. Rodriguez
Dr. Zankman
Dr. Lasala
Dr. Stevens
Dr. Richards
Dr. Krish
Nathan Harriman
Edgar Mayorquin
Alejandrina Orpineda
Gwendolyn Terrazas
Karina Cruz
Russell McNair
Lavonne Downing
Michael Kennedy
Myriam Villapudua
Alexa Barajas
Alma Herrera
Esteban Zermeno
Jesus Peralta
Karla Chavolla
Daniel Hammond
Myriam Hernandez
Jorge Herrera
Sarahi Leon
Martin Loaiza
Monica Lopez
Leah McNair
Rosie Medina
Mayra Montoya
Sharon Moreno
Katarina Olea
Nancy Rojas
Azucena Ramirez
Esteban Zermeno
Maria Y. Renteria
Ricardo Rivas
Claudia Rodriguez
Michael Schwegler
Alex Valenzuela
Angelica Villasenor
Lois Walker
#
Chart # (if applicable)
Date of Service
MM
/
DD
/
YYYY
Place:
San Luis 1896
Somerton 214
Somerton 950
FBIS 1130
San Luis Urgent Care
South County Diagnostics
Home Visit
Clinic Appointment
Enrollment Assitance
Reason for the Visit:
Wait Length of Time
More than 30 Minutes
15-30 Minutes
10-15 Minutes
5-10 Minutes
5 Minutes
Yes
No
Was the Doctor's explanation easy to understand
If No, please explain:
Yes
No
Does your Provider or assistant review your medication each visit?
Poor
Regular
Good
Excellent
Courtesy of Employees
Appearance of Office and Staff
Access to Appointments
Convenience of Location
TV
Newspaper
Friend
Other
How did you hear about the SLWIC?
Yes
No
Are the clinic's operational hours accessible to you and your family?
Did someone explain "Passport to Health" to you?
Does the practice helps coordinate your specialist appointments?
Overall were you satisfied with the care you received at the practice?
Email
Comments