Patient Satisfaction Survey: Age 64+
Please submit feedback regarding the quality of care that you receive at Midway Specialty Care Center as a patient, including this visit.
Gender *
Do you consider yourself Hispanic or Latino *
Race (Mark one or more) *
Required
General Health *
Very Good
Good
Fair
Poor
How would you rate your general health?
Ease of Getting Care *
Very Good
Good
Fair
Poor
Able to get appointments for checkups
Able to make same day appointment when sick or hurt
Health center hours work for me
Phone calls get through easily
I get called back quickly
Ableble to get medical advice when the office is closed
Length of time waiting at the clinic
Facility *
Very Good
Good
Fair
Poor
Easy to find the clinic
Lobby and waiting room was comfortable and clean
Exam room was comfortable and clean
Handicap accessibility
Front Desk *
Very Good
Good
Fair
Poor
Friedly and helpful you
Nurses and Medical Assistance *
Very Good
Good
Fair
Poor
Listens to you
Friendly and helpful to you
Answer your questions
Provider *
Very Good
Good
Fair
Poor
Listens to you
Spends enough time with you
Answers your questions
Friendly and helpful to you
Gives information you can understand
Considers your personal or family beliefs
Involves other doctors and caregives in your care when needed
Gives you good advice and treatment
Experience with Today's Visit *
Yes
No
Not Applicable
Did anyone ask if you have problems with the medicine you take?
Do you have problems getting your medication?
Did someone talk with you about goals for your health?
Did you get a copy of your care plan?
Were you asked if you had visits with other healthcare providers since your last visit with us?
Were you helped with making appointments to see other providers or for specialty care?
General *
Yes
No
Not Applicable
Have you ever been given information on what it means to have a "health home" or a "medical home"
If yes, do you feel that we are your health/medical home?
You may need other services that we do not provide. Have we helped you find other services you need?
Dou you feel that we can help you make healthy lifestyle choices?
Would you send your firends and family to us?
Dou you understand what we ask you to pay for your care?
Dou you feel what you pay is reasonable?
What one thing could we do to make your visits with us better?
Your answer
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