OUTREACH HEALTH SERVICES, INC. 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. You can help us by taking a minute to complete our survey. Thank you for your time.
Email address *
How long have you been a patient of Outreach Health Services? *
Your answer
How did you find out about us? (Please give appropriate answer). *
Race/Ethnicity: *
Please circle how you think we are doing in the following areas by using the scale listed below:
GREAT-5 GOOD-4 OK-3 FAIR-2 POOR1
EASE OF GETTING CARE: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Ability to get in to be seen 5 4 3 2 1
Hours Center is open:
Convenience of Center’s location:
Prompt returns on calls:
WAITING: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Time in waiting room:
Time in exam room:
Waiting for tests to be performed:
Waiting for test results:
STAFF: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Provider: (Physician, Dentist, Physician Asst, Nurse Practitioner)
Listens to you:
Takes enough time with you:
Explains what you want to know:
Gives you good advice and treatment:
NURSE AND MEDICAL ASSISTANTS *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Friendly and helpful to you:
Answers your questions:
FRONT DESK: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Friendly and helpful to you:
Answers your questions:
ADMINISTRATION: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Friendly and helpful to you:
Answers your questions:
Solve your problems:
PAYMENT: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
What you pay is reasonable:
Explanation of charges:
Collection of payment/money
Nominal fee preventing you access to care at OHS:
FACILITY: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Neat and clean building:
Ease of finding where to go:
Comfort and Safety while waiting:
CONFIDENTIALITY: *
GREAT (Agree
GOOD
OK
FAIR
POOR (Disagree):
Keeping my personal information private:
The likelihood of referring your friends and relatives to us
Do you consider this center your regular source of care?
What do you like best about our center? *
Your answer
What do you like least about our center? *
Your answer
Thank you for completing our Survey!
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