Cutler Health Center Patient Feedback SurveyCutler Health Center Patient Feedback Survey

1. Student/Employee Status

Student/Employee Status 1st

2nd

3rd

4th

5th

Graduate

UMaine Employee

2. Insurance Status

Insurance Status Family Plan

International Plan

UMaine Undergraduate Plan

Cigna (UM)

Anthem (UM)

No Insurance

Maine Care

Grad/GA/TA Plan

Not Sure

3. Accessing the Health Center

	Excellent	Fair	Poor
Ability to Be seen	*Accessing the Health Center Ability to Be seen Excellent	Ability to Be seen Fair	Ability to Be seen Poor
Clinic hours	Clinic hours Excellent	Clinic hours Fair	Clinic hours Poor
Scheduling/Registration Process	Scheduling/Registration Process Excellent	Scheduling/Registration Process Fair	Scheduling/Registration Process Poor
Getting through to clinic via phone	Getting through to clinic via phone Excellent	Getting through to clinic via phone Fair	Getting through to clinic via phone Poor

4. Wait times

	Excellent	Fair	Poor
Time in the waiting room	*Wait times Time in the waiting room Excellent	Time in the waiting room Fair	Time in the waiting room Poor
Wait time for provider	Wait time for provider Excellent	Wait time for provider Fair	Wait time for provider Poor

5. Support Staff (Check-In, Check-Out, Registration)

	Excellent	Fair	Poor
Friendly and helpful to you	*Support Staff (Check-In, Check-Out, Registration) Friendly and helpful to you Excellent	Friendly and helpful to you Fair	Friendly and helpful to you Poor
Prompt Service	Prompt Service Excellent	Prompt Service Fair	Prompt Service Poor
Answered your questions	Answered your questions Excellent	Answered your questions Fair	Answered your questions Poor
Explained payment process	Explained payment process Excellent	Explained payment process Fair	Explained payment process Poor
Explained insurance referral process (if applicable)	Explained insurance referral process (if applicable) Excellent	Explained insurance referral process (if applicable) Fair	Explained insurance referral process (if applicable) Poor

6. Nurse/Medical Staff

	Excellent	Fair	Poor
Friendly and helpful to you	*Nurse/Medical Staff Friendly and helpful to you Excellent	Friendly and helpful to you Fair	Friendly and helpful to you Poor
Answered your questions	Answered your questions Excellent	Answered your questions Fair	Answered your questions Poor

7. Provider Staff (MD, DO, FNP)

	Excellent	Fair	Poor
Friendly and helpful to you	*Provider Staff (MD, DO, FNP) Friendly and helpful to you Excellent	Friendly and helpful to you Fair	Friendly and helpful to you Poor
Spent adequate time answering your questions	Spent adequate time answering your questions Excellent	Spent adequate time answering your questions Fair	Spent adequate time answering your questions Poor

Provider Name (if known):

8. Facility

	Excellent	Fair	Poor
Neat and clean	*Facility Neat and clean Excellent	Neat and clean Fair	Neat and clean Poor
Ease of finding where to go	Ease of finding where to go Excellent	Ease of finding where to go Fair	Ease of finding where to go Poor
Privacy	Privacy Excellent	Privacy Fair	Privacy Poor

9. Student Wellness-- What programs would you like to see offered on campus?

Student Wellness-- What programs would you like to see offered on campus? Nutrition

Stress Management

Pregnancy Resources

Women's Health

Dental

Sexual Health

Smoking Cessation

Weight Managment

Athletic Training/Preventative Services

Other (please specify)

10. Please make suggestions for improvement. If you would like us to contact you about your visit today please leave your email or phone number

Please make suggestions for improvement. If you would like us to contact you about your visit today please leave your email or phone number

Cutler Health Center Patient Feedback Survey
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Cutler Health Center Patient Feedback SurveyExit this survey

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Cutler Health Center Patient Feedback Survey
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