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Northside Emergency Associates
 

Patient Survey


Please complete our survey if you are a recent Emergency Services patient at Northside Hospital Atlanta or Forsyth.
Your information is confidential; please see our privacy policy.

Which emergency department did you visit ?
Was this your first visit to Northside's emergency department?  
Date of your visit: month  day  year
Name of person seen if other than yourself:
Did the physician LISTEN to your concerns ?  
Were procedures/tests/treatment explained to you ?  
Were diagnosis and discharge instructions explained ?  
Please rate the following (#1 - #10)
#1 poorest #5 average #10 highest
• Physician
1 2 3 4 5 6 7 8 9 10
• Nurse Practitioner/Physician Assistant
1 2 3 4 5 6 7 8 9 10
• Customer Service
1 2 3 4 5 6 7 8 9 10
• Were your needs met
1 2 3 4 5 6 7 8 9 10
• Follow-up care provided
1 2 3 4 5 6 7 8 9 10
• Overall experience
1 2 3 4 5 6 7 8 9 10
Would you recommend Northside's emergency department to others ?  
Would you like to be contacted ?  
Your Name: *
Phone: *  ex.: xxx-xxx-xxxx
Comments:
* Required Fields

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