OUTREACH HEALTH SERVICES, INC. Patient Satisfaction Survey

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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 *

How long have you been a patient of Outreach Health Services? *

How did you find out about us? (Please give appropriate answer). *

Employer

Friend

Another Physician/Dentist

Hospital

School

Relative

Insurance Directory

Race/Ethnicity: *

Black/African American

White (Not Hispanic or Latino)

Asian

Pacific Islander

American Indian (Alaska Native)

Hispanic or Latina (All Races)

Unknown

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

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

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

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

FAIR

POOR (Disagree):

Friendly and helpful to you:

Answers your questions:

FRONT DESK: *

GREAT (Agree

GOOD

FAIR

POOR (Disagree):

Friendly and helpful to you:

Answers your questions:

ADMINISTRATION: *

GREAT (Agree

GOOD

FAIR

POOR (Disagree):

Friendly and helpful to you:

Answers your questions:

Solve your problems:

PAYMENT: *

GREAT (Agree

GOOD

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

FAIR

POOR (Disagree):

Neat and clean building:

Ease of finding where to go:

Comfort and Safety while waiting:

CONFIDENTIALITY: *

GREAT (Agree

GOOD

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? *

What do you like least about our center? *

Thank you for completing our Survey!

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