Patient Satisfaction Survey

Please answer the following questions about your experience with us:

Have you utilized Health Services within the last year?


On a scale of 1 to 5 (1 being very difficult and 5 being very easy), how was your experience making an
appointment in Health Services?


If our Receptionist provided you with service, please indicate your level of satisfaction with the Receptionist
(1 being unsatisfied and 5 very satisfied).


Were you greeted in a welcoming and helpful manner by our staff? (1 being very negative and 5 very positive)


During your most recent visit, did you see your healthcare provider in a timely manner of your appointment time?
Wait time includes time spent in the waiting room and exam room.
If not, how long was the wait from the scheduled time of appointment?


During your most recent visit if a Nurse assessed or treated you, please indicate your level of satisfaction with
the care provided (1 being unsatisfied and 5 very satisfied).


During your most recent visit if a Nurse Practitioner assessed or treated you, please indicate your level of
satisfaction with the care provided (1 being unsatisfied and 5 very satisfied).


During your most recent visit, if a Physician assessed or treated you, please indicate your level of satisfaction
with the care provided (1 being unsatisfied and 5 being very satisfied).


Indicate your level of satisfaction with the attention your Caregiver showed to your current condition and your
healthcare beliefs (1 being unsatisfied and 5 very satisfied).


Indicate your level of satisfaction with instructions and health education regarding
diagnosis/medications/lab tests/X-ray/referrals you received during your most recent visit (1 being unsatisfied
and 5 very satisfied).


Indicate your level of satisfaction with instructions you received about how to take care of yourself and if and
when you should return to Health Services (1 being not satisfied and 5 very satisified).


Were you notified of your lab results or x-ray results via phone call or secure message?


Were you satisfied with the cleanliness of Health Services (1 being unsatisfied and 5 very satisfied)?



If you wish to identify yourself for a follow-up interview, please leave your information below:

 
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