Patient Satisfaction Survey

Your feedback is important to us.

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* 1. You have recently been seen at UMC for a?

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* 2. Was this your first visit with us?

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* 3. What provider did you see today?

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* 4. Do you have insurance?

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* 5. If No, were you made aware of our Sliding Fee Scale?

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* 6. Do you have CICP or UMC Sliding Fee?

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* 7. If Yes, have you ever delayed care or postponed a visit to UMC due to the inability to pay the nominal fee(copay)?

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* 8. If Yes, do you feel the fee you are being charged for today's visit is fair for the quality and services provided by UMC?

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* 9. In the past 6 months... How often have you been able to see your health care team when you wanted to?

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* 10. In the past 6 months...How often has the staff treated you with courtesy and respect?

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* 11. In the past 6 months... Has anyone talked to your about how you can improve your health in the future?

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* 12. In the past 6 months... How often do you feel that everyone involved in your care worked well together?

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* 13. In the past 6 months... How often do you feel your provider has listened to you?

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* 14. Based on your care in the past 6 months... How likely are you to recommend us to family and friends?

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* 15. How did you get to today's appointment?

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* 16. Do you feel that UMC's hours meet your needs?

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* 17. How did you hear about us or the services we provide?

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* 18. Thinking about your most recent appointment, how would you rate... Respect of your privacy and confidentiality

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* 19. Thinking about your most recent appointment, how would you rate... the consideration of your financial situation

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* 20. Thinking about your most recent appointment, how would you rate... the cleanliness and up keep of the clinic

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* 21. Thinking about your most recent appointment... What was your overall rating of your experience at the clinic?

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* 22. How could we improve?

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* 23. What do we do well?

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* 24. Would you like to recognize someone who exceeded your expectations?

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* 25. Can UMC reach out to you regarding your feedback?

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* 26. If yes, please enter your name and contact information.

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