Patient Satisfaction Survey

Please take a few minutes to complete this survey. This will help Tandem Health Center work on any areas needing improvement in our Center.  As a valued patient, your input is very important to us. If you see more than one provider and would like to complete a survey for each provider that you see, please complete a second survey.  

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* 1. Please check by the name of your provider that you are thinking about when you answered the survey questions.  For this survey, please choose only one.  If you want to rate more than one provider, please complete a second survey.

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* 2. Is your healthcare provider, the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?

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* 3. How long have you been going to this Provider?

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* 4. In the last 12 months, how many times did you visit your Provider?

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* 5. In the last 12 months, when you phoned your Provider’s office to request a same day appointment, were you able to get it?

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* 6. In the last 12 months, when you phoned your Provider's office during regular office hours, how often did you get an answer to your medical question that same day?

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* 7. In the last 12 months, when you phoned your Provider's office after regular office hours, how often did you get an answer to your health question as soon as you needed?

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* 8. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see your Provider within 15 minutes of your appointment time?

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* 9. How long has it been since your most recent visit with your Provider?

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* 10. During your most recent visit, did your Provider explain things about your health in a way that was easy to understand?

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* 11. During your most recent visit, did your Provider listen carefully to you and show respect for what you had to say?

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* 12. During your most recent visit, did your Provider seem to know the important information about your medical history?

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* 13. During your most recent visit, did your Provider order any blood tests, x-rays, or other tests for you?

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* 14. How did you receive your test results? (skip if you did not get any testing done)

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* 15. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your Provider?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 16. Would you recommend your Provider’s office to your family and friends?

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* 17. During your most recent visit, were the people that helped you check in and register as helpful and courteous as you thought they should be?

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* 18. Did anyone offer you information about our sliding scale fee program?

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* 19. In general, how would you rate your overall health?

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* 20. What is your age?

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* 21. Please indicate your gender.

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* 22. What is the highest grade or level of school that you have completed?

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* 23. Are you of Hispanic or Latino origin or descent?

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* 24. What is your race? Mark one or more.

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* 25. If anyone helped you with completing this survey, please indicate how they helped you.  (You may select more than one answer if needed)

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* 26. Do you use the pharmacy at Tandem Health?

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* 27. Please rate the following for the pharmacy. (1 - Great, 2 - Fair, 3 - Poor)

  1 - Great 2 - Fair 3 - Poor
My wait time for picking up prescriptions is satisfactory.
The prices of my prescriptions are affordable.
The staff are professional and friendly.
I am offered education about my prescription.
My information is kept confidential.
What is the likelihood that you would refer this pharmacy to a friend?

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* 28. Please check all of the services that you and/or your immediate family members use at Tandem Health.

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* 29. Are there other things that we did not ask in this survey that you want to share with us?

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* 30. Please enter the date:

Date / Time

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