Telluride Medical Center Patient Satisfaction Survey

1. I visited the Telluride Medical Center for the following reason:

I visited the Telluride Medical Center for the following reason: 1. Primary Care/Family Practice

2. Emergency Services

3. Lab (blood draw), X-ray or CT Scan

4. Aesthetic Skin Care

Other (please specify)

2. Medical Provider on Last Visit:

	Yes
Dr. Peter Hackett	*Medical Provider on Last Visit: Dr. Peter Hackett Yes
Dr. Dan Hehir	Dr. Dan Hehir Yes
Dr. Diana Koelliker	Dr. Diana Koelliker Yes
Dr. Paul Koelliker	Dr. Paul Koelliker Yes
Dr. Sharon Grundy	Dr. Sharon Grundy Yes
Dr. Kent Gaylord	Dr. Kent Gaylord Yes
Laura Cattell, PA-C	Laura Cattell, PA-C Yes
Eric Johnson, NP-C	Eric Johnson, NP-C Yes
Dr. Jeffrey Ptak	Dr. Jeffrey Ptak Yes
Other	Other Yes

Comments (Optional):

3. Are you -

Are you - 1. An established patient of the medical center? or

2. A new patient?

4. Your Medical Providers

	Poor	Fair	OK	Good	Great	N/A
Was knowledgeable about your case?	*Your Medical Providers Was knowledgeable about your case? Poor	Was knowledgeable about your case? Fair	Was knowledgeable about your case? OK	Was knowledgeable about your case? Good	Was knowledgeable about your case? Great	Was knowledgeable about your case? N/A
Gave you their full attention?	Gave you their full attention? Poor	Gave you their full attention? Fair	Gave you their full attention? OK	Gave you their full attention? Good	Gave you their full attention? Great	Gave you their full attention? N/A
Spent adequate time with you?	Spent adequate time with you? Poor	Spent adequate time with you? Fair	Spent adequate time with you? OK	Spent adequate time with you? Good	Spent adequate time with you? Great	Spent adequate time with you? N/A
Answered your questions to your satisfaction?	Answered your questions to your satisfaction? Poor	Answered your questions to your satisfaction? Fair	Answered your questions to your satisfaction? OK	Answered your questions to your satisfaction? Good	Answered your questions to your satisfaction? Great	Answered your questions to your satisfaction? N/A
Provided appropriate advice, treatment and referral?	Provided appropriate advice, treatment and referral? Poor	Provided appropriate advice, treatment and referral? Fair	Provided appropriate advice, treatment and referral? OK	Provided appropriate advice, treatment and referral? Good	Provided appropriate advice, treatment and referral? Great	Provided appropriate advice, treatment and referral? N/A
Returned phone calls in a reasonable time?	Returned phone calls in a reasonable time? Poor	Returned phone calls in a reasonable time? Fair	Returned phone calls in a reasonable time? OK	Returned phone calls in a reasonable time? Good	Returned phone calls in a reasonable time? Great	Returned phone calls in a reasonable time? N/A
Refilled prescriptions in a reasonable time?	Refilled prescriptions in a reasonable time? Poor	Refilled prescriptions in a reasonable time? Fair	Refilled prescriptions in a reasonable time? OK	Refilled prescriptions in a reasonable time? Good	Refilled prescriptions in a reasonable time? Great	Refilled prescriptions in a reasonable time? N/A
Reviewed your lab results with you in a timely fashion?	Reviewed your lab results with you in a timely fashion? Poor	Reviewed your lab results with you in a timely fashion? Fair	Reviewed your lab results with you in a timely fashion? OK	Reviewed your lab results with you in a timely fashion? Good	Reviewed your lab results with you in a timely fashion? Great	Reviewed your lab results with you in a timely fashion? N/A

Comments (Optional):

5. Primary Care Medical Assistants & Nurses:

	Poor	Fair	OK	Good	Great	N/A
Were the Medical Assistants and or Nurses friendly, helpful and pleasant?	*Primary Care Medical Assistants & Nurses: Were the Medical Assistants and or Nurses friendly, helpful and pleasant? Poor	Were the Medical Assistants and or Nurses friendly, helpful and pleasant? Fair	Were the Medical Assistants and or Nurses friendly, helpful and pleasant? OK	Were the Medical Assistants and or Nurses friendly, helpful and pleasant? Good	Were the Medical Assistants and or Nurses friendly, helpful and pleasant? Great	Were the Medical Assistants and or Nurses friendly, helpful and pleasant? N/A

Comments (Optional):

6. Appointments & Registration:

	Poor	Fair	OK	Good	Great	N/A
Did you find your interaction with the Front Desk staff to be friendly and helpful?	*Appointments & Registration: Did you find your interaction with the Front Desk staff to be friendly and helpful? Poor	Did you find your interaction with the Front Desk staff to be friendly and helpful? Fair	Did you find your interaction with the Front Desk staff to be friendly and helpful? OK	Did you find your interaction with the Front Desk staff to be friendly and helpful? Good	Did you find your interaction with the Front Desk staff to be friendly and helpful? Great	Did you find your interaction with the Front Desk staff to be friendly and helpful? N/A
Did they answer questions to your satisfaction?	Did they answer questions to your satisfaction? Poor	Did they answer questions to your satisfaction? Fair	Did they answer questions to your satisfaction? OK	Did they answer questions to your satisfaction? Good	Did they answer questions to your satisfaction? Great	Did they answer questions to your satisfaction? N/A
My appointment was scheduled to my satisfaction?	My appointment was scheduled to my satisfaction? Poor	My appointment was scheduled to my satisfaction? Fair	My appointment was scheduled to my satisfaction? OK	My appointment was scheduled to my satisfaction? Good	My appointment was scheduled to my satisfaction? Great	My appointment was scheduled to my satisfaction? N/A
Did you see your provider promptly?	Did you see your provider promptly? Poor	Did you see your provider promptly? Fair	Did you see your provider promptly? OK	Did you see your provider promptly? Good	Did you see your provider promptly? Great	Did you see your provider promptly? N/A

If you experienced excessive wait time, how long and where did you wait

7. Facility:

	Poor	Fair	OK	Good	Great	N/A
Was the building neat and clean?	*Facility: Was the building neat and clean? Poor	Was the building neat and clean? Fair	Was the building neat and clean? OK	Was the building neat and clean? Good	Was the building neat and clean? Great	Was the building neat and clean? N/A
Was your privacy maintained?	Was your privacy maintained? Poor	Was your privacy maintained? Fair	Was your privacy maintained? OK	Was your privacy maintained? Good	Was your privacy maintained? Great	Was your privacy maintained? N/A
How would you say this 'facility' compares with other facilities?	How would you say this 'facility' compares with other facilities? Poor	How would you say this 'facility' compares with other facilities? Fair	How would you say this 'facility' compares with other facilities? OK	How would you say this 'facility' compares with other facilities? Good	How would you say this 'facility' compares with other facilities? Great	How would you say this 'facility' compares with other facilities? N/A

What is your overall satisfaction with the facility?

8. Overall Experience:

	Poor	Fair	OK	Good	Great
How do you rate your overall visit experience?	*Overall Experience: How do you rate your overall visit experience? Poor	How do you rate your overall visit experience? Fair	How do you rate your overall visit experience? OK	How do you rate your overall visit experience? Good	How do you rate your overall visit experience? Great

Why was your experience not great?

9. TMC Billing:

	Poor	Fair	OK	Good	Great	N/A
Did you find your TMC bill to be user friendly?	*TMC Billing: Did you find your TMC bill to be user friendly? Poor	Did you find your TMC bill to be user friendly? Fair	Did you find your TMC bill to be user friendly? OK	Did you find your TMC bill to be user friendly? Good	Did you find your TMC bill to be user friendly? Great	Did you find your TMC bill to be user friendly? N/A
Did we bill your insurance correctly/timely?	Did we bill your insurance correctly/timely? Poor	Did we bill your insurance correctly/timely? Fair	Did we bill your insurance correctly/timely? OK	Did we bill your insurance correctly/timely? Good	Did we bill your insurance correctly/timely? Great	Did we bill your insurance correctly/timely? N/A

How can we improve? (Optional):

10. Your Feedback - Please

What other feedback can you give us to help provide you with the care and services you desire?

Your Feedback - Please What other feedback can you give us to help provide you with the care and services you desire?

Telluride Medical Center Patient Satisfaction SurveyExit this survey

1. I visited the Telluride Medical Center for the following reason:

2. Medical Provider on Last Visit:

3. Are you -

4. Your Medical Providers

5. Primary Care Medical Assistants & Nurses:

6. Appointments & Registration:

7. Facility:

8. Overall Experience:

9. TMC Billing:

10. Your Feedback - PleaseWhat other feedback can you give us to help provide you with the care and services you desire?

Telluride Medical Center Patient Satisfaction Survey
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10. Your Feedback - Please

What other feedback can you give us to help provide you with the care and services you desire?