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.
 
Once you complete this survey you will be prompted to enter your name and information for drawing entry.  If your name has been entered, you will be in the drawing.  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 did you visit today?

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

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* 4. How satisfied were you with our check-in process & was the process friendly and courteous?

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

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* 6. How long was your waiting time in the reception area before your scheduled appointment?

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

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* 8. Was the nurse courteous & did the nurse listen to your needs?

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* 9. Was the Provider courtesy to you & did he/she take the time to listen to you?

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* 10. Define what cultural sensitivity means to you as a patient of NMPH?

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* 11. Describe the quality of the time spent with your Provider during your visit?

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* 12. Were you satisfied with the explanation from your Provider about your health care?

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

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* 14. How did your Provider respond to your concerns and sensitivity about your health care?

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

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

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* 18. How would you prefer Health Education & Outreach Material?

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

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* 20. Are the current NMPH hours of operation convenient for you?

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* 21. If you wish to opt in with any of the provided communication please complete.

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

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

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