Screen Reader Mode Icon

Patient Satisfaction Survey

We would like to know how you feel about the services we provide.  Your responses are directly responsible for improving these services.  All responses will be kept confidential and anonymous.  Thank you for your time!

Question Title

* 1. Today's Date

Date

Question Title

* 2. What Clinic Did you visit today?

Question Title

* 3. What is your age?

Question Title

* 4. What is your Ethnicity

Question Title

* 5. Who are you here to see today?

Please tell us how well you think we are doing in the following areas by using the ranking sections below.
EASE OF RECEIVING CARE:

Question Title

* 6. Ability to be seen

Question Title

* 7. Hours the Center is open

Question Title

* 8. Convenience of Center's Location

Question Title

* 9. Prompt on Return Calls

WAITING:

Question Title

* 10. Time in Waiting Room

Question Title

* 11. Time in exam room

Question Title

* 12. Waiting for tests to be performed

Question Title

* 13. Waiting for test results

STAFF: (The Professional who provided you care)

Question Title

* 14. Listens to you

Question Title

* 15. Takes enough time with you

Question Title

* 16. Explains what you want to know

Question Title

* 17. Gives you good advice and treatment

STAFF: (Assistants, Case Managers, Receptionists)

Question Title

* 18. Friendly and helpful to you

Question Title

* 19. Answers your questions

PAYMENT:

Question Title

* 20. What you pay

Question Title

* 21. Explanation of charges

Question Title

* 22. Collection of payment / money

FACILITY:

Question Title

* 23. Neat and Clean Building

Question Title

* 24. Ease of finding where to go

Question Title

* 25. Comfort and safety while waiting

CONFIDENTIALITY:

Question Title

* 26. Privacy of exam rooms

Question Title

* 27. Our concern for your privacy

We appreciate your feedback on the following:

Question Title

* 28. Would you send your family and friends to us?

Question Title

* 29. Do you consider this Center your regular source of care?

Question Title

* 30. What do you like best about our Center?

Question Title

* 31. What do you like least about our Center?

Question Title

* 32. Suggestions for improvement?

Question Title

* 33. Anyone who provided exceptional service you would like to mention?

Please continue to the below section to provide us with feed back regarding Telehealth Visits

Question Title

* 34. Did you have any telehealth visits with us this year?

Question Title

* 35. Do you prefer telehealth rather than in-person visits for routine checkups?

Question Title

* 36. Do you prefer telehealth rather than in-person visits for urgent care needs?

Question Title

* 37. How would you rate your overall telehealth experience

WE APPRECIATE YOU TAKING THE TIME TO COMPLETE OUR SURVEY!!  MAHALO!
0 of 37 answered
 

T