displaying date Wait TimeQuestion $1$: How many minutes did you have to wait before being called back by the triage nurse?AgeQuestion $2$: How old are you? $$WeightQuestion $3$: What was your weight to the nearest pound? $$HeightQuestion $4$: What was your height to the nearest inch? $$TemperatureQuestion $5$: What was your temperature at the time of the ER visit? $$InsuranceQuestion $6$: What is the name of your medical insurance company? $$Out$-$of$-$pocket payQuestion $7$: How much did you pay on the same day of the visit to the nearest dollar? Do NOT include what you were billed after the visit. $$Annual Household incomeQuestion $8$: How much, to the nearest dollar, is your annual household income? $$Satisfaction

Question $9$: $$How satisfied were you with your most recent visit to the ER$?$

Completely Dissatisfied

Dissatisfied

Average

Satisfied$$

Completely Satisfied$$