Shot Room Survey

Family Allergy & Asthma and Arkansas Allergy & Asthma Clinic


* 1.) Which shot room did you visit?
* 2.) Did the staff greet you?
* 3.) Once you scanned your card, approximately how long did you wait before being called for your shot?
* 4.) Did the shot room staff call you by your first name only?
* 5.) Did the shot room staff confirm your date of birth prior to giving you your shot?
* 6.) Were you asked about any problems with breathing prior to receiving your shot?
* 7.) Is the waiting room kept neat and clean?
* 8.) Is there adequate seating available in the waiting room?
* 9.) Is the shot room appropriately staffed to handle the number of shot patients?
10.) Do you have any additional comments or feedback?