School Based Patient Satisfction Survey
PATIENT SATISFACTION
1.
What clinic are you visiting today?
Pointe Coupee School Based Health
Livonia School Based Health
Brusly School Based Health Center
North Iberville School Based Health Center
Other (please specify)
2.
Are you new to the Health Center?
Today is the first time I have visited the health center.
Today is the first time I have visited the health center this school year.
I have visited the health center this school year.
Not Sure
3.
At today's visit, did the provider:
Yes
No
Not Sure
I don't want to answer
Spend enough time with you?
Yes
No
Not Sure
I don't want to answer
Listen carefully to you?
Yes
No
Not Sure
I don't want to answer
Make you fell comfortable to ask any type of question?
Yes
No
Not Sure
I don't want to answer
Ask about your physical health (body changes, weight, etc.)?
Yes
No
Not Sure
I don't want to answer
Ask about your emotional health (feeling sad, stressed, anxious, etc.)
Yes
No
Not Sure
I don't want to answer
Let you know that certain things you talked about are private (not shared with anyone else)?
Yes
No
Not Sure
I don't want to answer
4.
What do you think about the clinic after your visit?
Yes
No
Not Sure
I don't want to answer.
I'm comfortable talking with the provider about things (my health, life at home, things that bother me).
Yes
No
Not Sure
I don't want to answer.
I can get information to understand my health.
Yes
No
Not Sure
I don't want to answer.
I know how to contact the clinic if I have any questions or problems.
Yes
No
Not Sure
I don't want to answer.
The front desk staff make me feel welcome.
Yes
No
Not Sure
I don't want to answer.
It's easy to get an appointment today.
Yes
No
Not Sure
I don't want to answer.
I don't have to wait too long for an appointment.
Yes
No
Not Sure
I don't want to answer.
5.
What do you think about the clinic space?
Yes
No
Not Sure
Don't want to answer
The waiting room is comfortable.
Yes
No
Not Sure
Don't want to answer
It is clean.
Yes
No
Not Sure
Don't want to answer
It is set up so I can talk with front desk staff without other people hearing me.
Yes
No
Not Sure
Don't want to answer
The posters and brochures are interesting to me.
Yes
No
Not Sure
Don't want to answer
Clinic hours are at a time that I can come.
Yes
No
Not Sure
Don't want to answer
6.
Were you happy with your visit today?
Yes
No
Not Sure
Don't want to say.
Comment
7.
Would you come back to the clinic?
Yes
No
Not sure
Don't want to answer
Comment
8.
What else would you like to tell us?
