PATIENT SATISFACTION SURVEY

Please take a moment to share your thoughts regarding your recent visit with us by filling out our survey online. Your confidential responses will assist us in improving our services and addressing areas where we can better meet your needs. Thank you for sharing your observations with us.

Who Did You See Today:

Month:

Your Age:

Your Sex:

How likely is it that you would recommend our services to a friend or relative?

Please rate how well you think we are doing in the following areas.

EASE OF GETTING CARE:

Ability to be seen by my provider

Hours the center is open

Convenience of the center’s location

Prompt return on calls

WAITING:

Time in the waiting room

Time in the exam room

Wait time for tests to be performed

Wait time for test results

PROVIDER:

Listens to me

Takes enough time with me

Explains what I want to know

Provides good advice and treatment

MEDICAL/DENTAL ASSISTANTS:

Friendly and helpful to me

Answers my questions

ALL OTHER STAFF:

Staff was friendly and helpful to me

Staff answered my questions

PAYMENT:

Value of services provided based on what I paid

Affordability of the care received

Access to the Sliding Fee Scale (for payment or to determine eligibility)

FACILITY:

Neat and clean building

Ease of finding where to go

Comfort and safety while waiting

Privacy of the environment

Patient Safety:

I felt safe with the care I received, and while I was at the facility

Digital Tools (Answer those that apply)

The patient portal is easy to use and improves my experience

I utilize telehealth visits and find them a great tool for my overall care

LIKELY TO RECOMMEND:

Overall, how satisfied are you with your recent visit to the Health Center?

How can we make your experience at Nasson Health Care better?

Name (optional)

First Last

Email (optional)

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