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Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.
Your Age *
Your Sex *
Your Race/Ethnicity *
Please select how well you think we are doing in the following areas:
Ease of Getting Care
Ability to get in to be seen? *
Very difficult
Very easy
Hours Sapphire Community Health is open? *
Very dissatisfied
Very satisfied
Convenience of Sapphire Community Health’s location? *
Very inconvenient
Very convenient
Prompt return of phone calls? *
Very dissatisfied
Very satisfied
Waiting
Time spent in waiting room? *
Much too long
Much too short
Time spent waiting in exam room? *
Much too long
Much too short
Time spent waiting for tests to be performed? *
Much too long
Much too short
Time spent waiting for test results? *
Much too long
Much too short
Your Provider
(Physician, Dentist, Physician Assistant, Nurse Practitioner)
Listens to you? *
Strongly disagree
Strongly agree
Takes enough time with you? *
Strongly disagree
Strongly agree
Explains what you want to know? *
Strongly disagree
Strongly agree
Gives you good advice and treatment? *
Strongly disagree
Strongly agree
Nurses and Medical Assistants
Are friendly and helpful to you? *
Strongly disagree
Strongly agree
Answer your questions? *
Strongly disagree
Strongly agree
All other Sapphire Community Health staff
Are friendly and helpful to you? *
Strongly disagree
Strongly agree
Answers your questions? *
Strongly disagree
Strongly agree
Payment and Fees
How satisfied are you with the amount you pay for services? *
Very dissatisfied
Very satisfied
How satisfied are you with our explanation of the charges for the services we provide? *
Very dissatisfied
Very satisfied
How satisfied are you with our process for the collection of payment/money for the services we provide? *
Very dissatisfied
Very satisfied
Facility
How neat and clean do you find our building? *
Very messy and unclean
Very neat and clean
How easy is it to find where you need to go within our building? *
Very difficult
Very easy
How comfortable and safe do you feel while waiting in our building? *
Very unsafe
Very safe
How confident are you in the level of patient privacy in our building? *
Not at all confident
Extremely confident
Confidentiality
At what level of priority do you feel Sapphire Community Health keeps your personal information private? *
Not important at all
The most important priority
Overall Satisfaction
How likely are you to refer your friends and relatives to us? *
Very unlikely
Very likely
Is Sapphire Community Health your regular source of healthcare? *
Required
What do you like the best about Sapphire Community Health? *
Your answer
What do you like the least about Sapphire Community Health? *
Your answer
Suggestions for improvement? *
Your answer
Thank you for completing our Survey all information is confidential and will be used to improving our clinical services.
Patient Satisfaction Survey, Supported by funds from the Bureau of Primary Health Care
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