Patient Satisfaction Survey

Please take a few minutes to complete this survey. This will help Tandem Health work on any areas needing improvement in our Center.  As a valued patient, your input is very important to us.

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* 1. Please check by the name of your provider that you saw today. For this survey, please choose only one.

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* 2. How easily can you get in to see your usual provider if you need a well check-up, medical advice, or evaluation of an illness or injury?

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

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* 4. In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?

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* 5. 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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* 6. In the last 12 months, how often were you able to get the care you needed from this provider's office during evening, weekends, or holidays?

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* 7. In the last 12 months, what was your estimated/average wait time for your appointment? Wait time includes time spent in the waiting room and exam room.

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* 8. During your visit today, did your provider give you easy to understand information about your questions or concerns?

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* 9. During your visit today, did your provider show respect for what you had to say?

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* 10. During your visit today, did your provider seem to know the important information about your medical history?

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* 11. If your provider has recently ordered any blood tests, x-rays, or other tests, how did you receive your test results? (skip if you did not get any testing done)

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* 12. Using any number from 1 to 10, where 1 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your Provider?

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* 13. Would you recommend your provider’s office to your family and friends?

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* 14. Based on your most recent visit, please rate your satisfaction.

  Very Satisfied Somewhat Satisfied Dissatisfied
Front Desk
Nurse
Provider

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* 15. Did anyone speak with you about our sliding fee discount program today?

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* 16. What is your age?

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* 17. Please indicate your gender.

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

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

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

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* 21. 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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* 22. Do you use the pharmacy(s) at Tandem Health?

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* 23. If you answered "yes" to the previous question, please rate your level of agreeance. ( I Agree , I Somewhat Agree , I Do Not Agree )

  I Agree I Somewhat Agree I Do Not Agree
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 prescriptions.
My information is kept confidential.
I am likely to refer this pharmacy to a friend.

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

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* 25. What other things would you like to share with us that we did not ask you in this survey?

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* 26. Please enter today's date:

Date

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