Access and Communication Satisfaction Survey

We know we can do better responding to your health care needs. Your confidential feedback will be used to improve our care and services. There are only 10 easy questions. THANKS!

1. In the last 12 months, how often were clerks and receptionists at Evergreen Family Health as helpful as you thought they should be?

In the last 12 months, how often were clerks and receptionists at Evergreen Family Health as helpful as you thought they should be? Never

Almost Never

Sometimes

Usually

Almost Always

Always

Other (please specify)

2. In the last 12 months, when you made an appointment for the following types of care, how often did you get an appointment as soon as you thought you needed? (if you didn't request a visit type, leave row blank)

	Never	Almost Never	Sometimes	Usually	Almost Always	Always
Urgent medical need	*In the last 12 months, when you made an appointment for the following types of care, how often did you get an appointment as soon as you thought you needed? (if you didn't request a visit type, leave row blank) Urgent medical need Never	Urgent medical need Almost Never	Urgent medical need Sometimes	Urgent medical need Usually	Urgent medical need Almost Always	Urgent medical need Always
Routine visit or follow-up care	Routine visit or follow-up care Never	Routine visit or follow-up care Almost Never	Routine visit or follow-up care Sometimes	Routine visit or follow-up care Usually	Routine visit or follow-up care Almost Always	Routine visit or follow-up care Always
Health maintenance or "Physical"	Health maintenance or "Physical" Never	Health maintenance or "Physical" Almost Never	Health maintenance or "Physical" Sometimes	Health maintenance or "Physical" Usually	Health maintenance or "Physical" Almost Always	Health maintenance or "Physical" Always

3. In the last 12 months, when you phoned EVERGREEN FAMILY HEALTH with a medical question DURING REGULAR OFFICE HOURS, how often did you get an answer to your question that same day?

In the last 12 months, when you phoned EVERGREEN FAMILY HEALTH with a medical question DURING REGULAR OFFICE HOURS, how often did you get an answer to your question that same day? Never

Almost Never

Sometimes

Usually

Almost Always

Always

Not Applicable (Did not request this service)

4. In the last 12 months, when you phoned Evergreen Family Health AFTER REGULAR OFFICE HOURS, how often did you get an answer to your medical question as soon as you needed?

In the last 12 months, when you phoned Evergreen Family Health AFTER REGULAR OFFICE HOURS, how often did you get an answer to your medical question as soon as you needed? Not Applicable (Did not call after hours)

Never

Almost Never

Sometimes

Usually

Almost Always

Always

5. Please indicate your personal practitioner, with whom you would typically request a routine visit, a check up, or seek medical advice:

Please indicate your personal practitioner, with whom you would typically request a routine visit, a check up, or seek medical advice: Paul Reiss, MD

Jan Ferris, DO

James Dougherty, MD

Michael Johnson, MD

Molly Backup, PA-C

Nancy Resi, FNP

Patrick Kearney, PA

No Preference

6. Over the past 12 months, how often were you able to get an appointment with THIS PRACTITIONER when you requested it?

Over the past 12 months, how often were you able to get an appointment with THIS PRACTITIONER when you requested it? Never

Almost Never

Sometimes

Usually

Almost Always

Always

Didn't request a specific practitioner

7. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see THIS PRACTITIONER within 15 minutes of your appointment time?

Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see THIS PRACTITIONER within 15 minutes of your appointment time? Never

Almost Never

Sometimes

Usually

Almost Always

Always

(Not Applicable)

8. In the last 12 months, how often did THIS PRACTITIONER spend enough time with you, and explain things in a way that were easy to understand?

In the last 12 months, how often did THIS PRACTITIONER spend enough time with you, and explain things in a way that were easy to understand? Never

Almost Never

Sometimes

Usually

Almost Always

Always

(Not applicable)

Other (please specify)

9. In the last 12 months, when your practitioner ordered a blood test, x-ray or other test for you, how often did someone from Evergreen Family Health follow up in reasonable time to give you those results?

In the last 12 months, when your practitioner ordered a blood test, x-ray or other test for you, how often did someone from Evergreen Family Health follow up in reasonable time to give you those results? Never

Almost Never

Sometimes

Usually

Almost Always

Always

(Not Applicable)

10. Overall how satisfied are you with your experiences at Evergreen Family Health?

Overall how satisfied are you with your experiences at Evergreen Family Health? Extremely Satisfied / Pleased

Very Satisfied / Pleased

Mostly Satisfied / Pleased

Unsure / Neutral

Somewhat dissatisfied, displeased

Very dissatisfied / displeased

Other (please specify)

Access and Communication SatisfactionExit this survey >>

1. In the last 12 months, how often were clerks and receptionists at Evergreen Family Health as helpful as you thought they should be?

2. In the last 12 months, when you made an appointment for the following types of care, how often did you get an appointment as soon as you thought you needed? (if you didn't request a visit type, leave row blank)

3. In the last 12 months, when you phoned EVERGREEN FAMILY HEALTH with a medical question DURING REGULAR OFFICE HOURS, how often did you get an answer to your question that same day?

4. In the last 12 months, when you phoned Evergreen Family Health AFTER REGULAR OFFICE HOURS, how often did you get an answer to your medical question as soon as you needed?

5. Please indicate your personal practitioner, with whom you would typically request a routine visit, a check up, or seek medical advice:

6. Over the past 12 months, how often were you able to get an appointment with THIS PRACTITIONER when you requested it?

7. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see THIS PRACTITIONER within 15 minutes of your appointment time?

8. In the last 12 months, how often did THIS PRACTITIONER spend enough time with you, and explain things in a way that were easy to understand?

9. In the last 12 months, when your practitioner ordered a blood test, x-ray or other test for you, how often did someone from Evergreen Family Health follow up in reasonable time to give you those results?

10. Overall how satisfied are you with your experiences at Evergreen Family Health?

Access and Communication Satisfaction
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