Northeastern Tribal Health System Patient Survey Question Title * 1. Appointment available within a reasonable time? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 2. Overall efficiency of check-in process? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 3. Wait time in the reception area? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 4. Wait time in the exam room? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 5. If appointment was delayed, how well did we do at keeping you informed of the delay? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 6. If a referral was required, how did we do at making the process easy for you? Very satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 7. Courtesy of the person who checked you in? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 8. Caring / Concern of the NTHS staff? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 9. Professionalism of the NTHS staff? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 10. Helpfulness of the staff assisting you with a referral to an outside facility? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 11. Phone calls are returned promptly? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 12. Getting advice or help when needed during normal office hours? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 13. Explanation of your health concerns / questions? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 14. Test results available within a reasonable amount of time? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 15. Clarity and effectiveness of the health information material provided? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 16. Awareness of your medical home provider / team members? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 17. Willingness to listen to you carefully? Very Satisfied Somewhat Satisfied Neutral Somewhat Disatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 18. Taking time to answer your questions? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 19. Amount of time spent with you? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 20. Explaining things in a way you can understand? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 21. Thoroughness of the examination? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 22. Instructions regarding medications and follow up care? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 23. Wait time for your in-clinic prescriptions to be filled? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 24. Wait time for mail order prescriptions to be filled? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 25. Interactions with the pharmacy staff? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 26. Overall satisfaction with the clinic? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 27. Overall comfort of the clinic? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 28. Cleanliness of the clinic? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 29. Ease of understanding signage and directions? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 30. Quality of your medical home care? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 31. Overall satisfaction of care from your medical home provider? Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied N/A Other (please specify) OK Question Title * 32. How satisfied would you be if your patient records were available electronically? Very satisfied Somewhat satisfied Neutral Somewhat dissatisfied Very dissatisfied N/A Other (please specify) OK Question Title * 33. Suggestions for improvement: OK DONE