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GMHC Farmington Patient Satisfaction Survey
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1.
Which one of our departments did you recently visit at our Farmington location?
(Required.)
Farmington Medical
Farmington Dental
2.
Were you asked if you had visits with other healthcare providers
since your last visit with us?
Yes
No
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3.
How would you rate your ease of getting care/making appointments?
(Required.)
Excellent
Good
Fair
Poor
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4.
How would you rate your ability to get medical/dental advice when the office is closed?
(Required.)
Excellent
Good
Fair
Poor
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5.
How would you rate your satisfaction with your provider/staff?
(Required.)
Excellent
Good
Fair
Poor
6.
How would you rate your provider on getting you answers and/or making you feel respected?
Excellent
Good
Fair
Poor
If you would like to give a "shout out" to a specific employee please leave their name in the comment box so they can be recognized.
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7.
You may need other services that we do not provide. How would you rate the help/contact information you received from our staff for these services?
(Required.)
Excellent
Good
Fair
Poor
8.
How are our costs, collections, and explanation of benefits in comparison to other local healthcare providers providing similar services?
Excellent
Good
Fair
Poor
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9.
Will you return to GMHC for care?
(Required.)
Yes
No
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10.
Will you recommend GMHC to friends/family?
(Required.)
Yes
No
11.
Overall, was the facility clean?
Yes
No
Other (please specify)
12.
Are you currently aware of our sliding scale discount?
Yes
No
13.
If you answered yes to the last question, Which Federal Poverty Level percentage do you fall within:
0-100%
101-133%
134-167%
168-200%
N/A, I answered no to the last question.
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14.
How long was your wait time in the waiting room?
(Required.)
Long (greater than 10 minutes)
Average (5-10 minutes)
Short (Less than 5 minutes)
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15.
How long was your wait time in the exam room?
(Required.)
Long (greater than 10 minutes)
Average (5-10 minutes)
Short (less than 5 minutes)
16.
Do you currently have transportation?
Yes
No, I am not interested in transportation resources.
No, I AM interested in transportation resources. (Please call us at 573-438-9355 for further information)
17.
Great Mines offers same-day appointments at 12:30pm each day. Does this time work for your same-day needs?
Yes, this meets my needs
No, I prefer mornings same-day
Other (please specify)
18.
Please provide any suggestions or additional feedback.
19.
To be entered into our drawing for the survey drawing please provide your name and contact information. (Optional)
