Please take a few minutes to fill out this survey on the timeliness and quality of the service you and/or your dependents receive at Nimiipuu Health (NMPH).  Your feedback and answers will be kept confidential.
 
Drawings will be held for patients that have submitted a survey during each quarter period.  Once you complete this survey you will be prompted to enter your name and information for drawing entry.  Only one entry per person.  Qe’ciyéw’yew’ (Thank You).

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* 1. Check One

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* 2. What patient service of NMPH did you visit today?

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* 3. How easy was it to schedule your appointment?

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* 4. Were you satisfied with the Check-In process?

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* 5. How friendly and courteous was the Check-In staff member?

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* 6. Select your time of arrival to your appointment.

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* 7. What was your waiting time in the reception area before your scheduled appointment?

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* 8. How much time did you spend in the exam room while waiting for your medical staff member to arrive?

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* 9. Were you Informed of time delays about your appointment?

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* 10. What was the personal manner (caring, respect, sensitivity, friendliness) of the medical staff member who cared for you during your visit?

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* 11. How well do NMPH staff members understand the cultural needs of patients?

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* 12. Describe the quality of the time spent with your provider during your visit?

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* 13. Were you satisfied with the explanation about your health care?

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* 14. Describe the technical/professional skills (thoroughness, carefulness, competence) of the staff helping you.

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* 15. How did your provider respond to your concerns and sensitivity about your health care?

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* 16. Did your provider involve you when making treatment decisions and did he/she empower you to participate in your health care?

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* 17. If you received a referral, how clear was the explanation of the process as explained to you by staff?

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* 18. How easy is it to schedule follow-up appointments?

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* 19. How helpful are the health information and patient education materials (pamphlets, flyers, TV, etc.) displayed throughout the clinic?

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* 20. Overall, how do you rate the quality of your visit?

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* 21. Would you like someone to contact you regarding your responses to this survey?

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* 22. Thank you for your participation. Please, provide your contact information if you would like to be entered into the next door prize drawing.

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