Satisfaction with Nursing Services Survey
Exit this survey
1. About Your Meeting
*
1
. Where did most of your contact with the nurse happen?
Where did most of your contact with the nurse happen?
Clinic
Home Visit
Office
Phone Contact
Other (please specify)
2
. The nurse I met with:
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Does not apply
Was friendly.
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The nurse I met with: Was friendly. Strongly disagree
Was friendly. Disagree
Was friendly. Neutral
Was friendly. Agree
Was friendly. Strongly agree
Was friendly. Does not apply
Gave me information about my health concerns.
Gave me information about my health concerns. Strongly disagree
Gave me information about my health concerns. Disagree
Gave me information about my health concerns. Neutral
Gave me information about my health concerns. Agree
Gave me information about my health concerns. Strongly agree
Gave me information about my health concerns. Does not apply
Gave me satisfactory services.
Gave me satisfactory services. Strongly disagree
Gave me satisfactory services. Disagree
Gave me satisfactory services. Neutral
Gave me satisfactory services. Agree
Gave me satisfactory services. Strongly agree
Gave me satisfactory services. Does not apply
Connected me to community resources.
Connected me to community resources. Strongly disagree
Connected me to community resources. Disagree
Connected me to community resources. Neutral
Connected me to community resources. Agree
Connected me to community resources. Strongly agree
Connected me to community resources. Does not apply
Kept scheduled appointments with me.
Kept scheduled appointments with me. Strongly disagree
Kept scheduled appointments with me. Disagree
Kept scheduled appointments with me. Neutral
Kept scheduled appointments with me. Agree
Kept scheduled appointments with me. Strongly agree
Kept scheduled appointments with me. Does not apply
3
. Please share any other thoughts you have about our services.
Please share any other thoughts you have about our services.
What do we do well?
What should we improve on?
Additional comments?
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