Request a Survey

We appreciate your honesty when filling out our surveys. Please note that responses will be reviewed by NextCare® Urgent Care management, and used to improve our operations and patient services. There are two options for submitting a confidential survey.

Electronic survey: If you recently visited a NextCare® Urgent Care, you will receive a brief electronic survey via email. Instructions for completing the survey process will be enclosed in the email.

Paper survey: You may request a paper survey in person at a NextCare® Urgent Care medical center at the time of your visit, or stop by any time to provide your comments and feedback.

If you would like to request a survey, fill out the information below:

Site:

Provider:

First Name:

Last Name:

Email:

Birth date:

Date of Visit:

Survey Language

Please enter the word you see in the image below: