Nominal Fee Satisfaction Survey

As a patient of Mercy Medical Health Center who is currently using our clinic for health care services, can you please answer the following:

Below is a list of charges for those who qualify for the nominal level sliding fee scale:
Medical Visit Fee: $10.00
Diabetic Nutritionist Fee: $10.00
Lab Corp Wellness Labs: $25.00
Dental Visit Fee: $60.00

In reviewing the charges above, please mark the box that best describes the fee.

1.Medical Visits

Fees are low and a good value for the services provided.

Fees are average and what I would expect to pay for the services provided.

Fees are high and more than I would expect to pay for the services.

2.Diabetic Nutritionist Visits

Fees are low and a good value for the services provided.

Fees are average and what I would expect to pay for the services provided.

Fees are high and more than I would expect to pay for the services.

3.Lab Services

Fees are low and a good value for the services provided.

Fees are average and what I would expect to pay for the services provided.

Fees are high and more than I would expect to pay for the services.

4.Dental Visits

Fees are low and a good value for the services provided.

Fees are average and what I would expect to pay for the services provided.

Fees are high and more than I would expect to pay for the services.

If you consider these fees high, what would you expect to pay for the following services?

5.Medical Visits

6.Diabetic Nutritionist Visits

7.Lab Visits

8.Dental Visits

9.Comments or concerns?

Create surveys and forms with ease. Sign up free.

Privacy & Cookie Notice