UHS Patient Satisfaction Survey

You were recently seen for an appointment at University Health Services. We value you as a patient and want to know if our services met your needs. As part of this effort, we would be grateful if you would take a few moments and complete this brief survey about your most recent visit. Your responses are completely confidential. The results of these questionnaires are used to evaluate and improve University Health Services. Thank you for your attention and time.

1. Is University Health Services your usual source of care and/or primary care provider?

Is University Health Services your usual source of care and/or primary care provider? Yes

2. Rate your satisfaction with the following related to your most recent visit

	0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Ease of scheduling an appointment that meets your needs	Rate your satisfaction with the following related to your most recent visit Ease of scheduling an appointment that meets your needs 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Amount of time needed in the health service to complete your appointment	Amount of time needed in the health service to complete your appointment 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Efficiency of the check-in and check-out process	Efficiency of the check-in and check-out process 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Friendliness, courtesy, and helpfulness of the registration staff	Friendliness, courtesy, and helpfulness of the registration staff 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Friendliness, courtesy and helpfulness of the non-provider medical staff (nurses, laboratory technician, medical assistant, etc.)	Friendliness, courtesy and helpfulness of the non-provider medical staff (nurses, laboratory technician, medical assistant, etc.) 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
That the provider listened carefully to your concerns	That the provider listened carefully to your concerns 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Amount of time spent with the provider	Amount of time spent with the provider 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Quality of the explanations and advice you were given for your condition and the recommended treatment	Quality of the explanations and advice you were given for your condition and the recommended treatment 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
How well your pain was addressed	How well your pain was addressed 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Explanations given about payment and billing issues	Explanations given about payment and billing issues 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Your confidentiality and privacy were carefully protected	Your confidentiality and privacy were carefully protected 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Cleanliness and general appearance of the health center	Cleanliness and general appearance of the health center 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
Your overall satisfaction with your visit	Your overall satisfaction with your visit 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied
How likely are you to recommend the health service to another student?	How likely are you to recommend the health service to another student? 0 - Not Satisfied	1	2	3	4	5	6 - Very Satisfied

3. Gender

Gender Male

Female

Transgender

4. Ethnic/Racial Background

Ethnic/Racial Background White-not Hispanic (includes Middle Eastern)

African-American/Black - not Hispanic

Hispanic or Latino

Asian or Pacific Islander

American Indian or Alaskan Native

Other

5. Program of Study

Program of Study Non-degree

Undergraduate

Graduate

Professional school

Faculty/Staff/Contract Employee

6. Please include any comments about your visit to the health service you would like us to know. If you would like a health service staff member to contact you, please include a telephone number and/or e-mail address. Thank-you for your time and attention.

Please include any comments about your visit to the health service you would like us to know. If you would like a health service staff member to contact you, please include a telephone number and/or e-mail address. Thank-you for your time and attention.