Patient Survey |
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Please help us evaluate our service to you by completing this survey. This survey may also be completed at the Sebastian Health Center. A collection box has been placed at the receptionist desk for your convenience. |
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1) Select any of the following options that apply: |
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Male |
Female |
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Resident Student |
Commuter |
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Freshman |
Sophomore |
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Junior |
Senior |
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Graduate |
Faculty/Staff |
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Other |
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2) Did you receive a friendly and professional welcome from the health center staff? |
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yes |
no |
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3) Did you have an appointment? |
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yes |
no |
| If yes, what was your appointment time ? |
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4) If you had an appointment, was your wait time before seeing the nurse greater than 20 minutes? |
yes |
no |
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5) If seen by the Physician, did he explain your diagnosis or procedure in terms that you understood? |
yes |
no |
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6) If labs were drawn today, was the lab staff friendly and courteous? |
yes |
no |
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7) If seen by medical records, were your questions answered in a helpful and courteous manner? |
yes |
no |
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8) If seen by the insurance department, were your questions answered in a helpful and courteous manner? |
yes |
no |
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9) Was the nursing staff friendly and courteous? |
yes |
no |
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10) If prescriptions were filled by the pharmacy, did you receive information on the medication (verbal or handout)? |
yes |
no |
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11) If seen by Health Educators, was information helpful and informative? |
yes |
no |
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12) If seen by the Referral Nurse, were your questions answered in a helpful and courteous manner.? |
yes |
no |
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13) Please mark the items below that you found satisfactory so we can improve on our customer service in the future |
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Physician Service |
Front Desk / Receptionist Service |
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Adequate counseling on the use of medications |
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Availability of educational materials |
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Length of time until appointment available |
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For scheduled appointments, wait time after arrival to see practitioner |
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For walk-ins, wait time after arrival to see practitioner |
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14) Additional comments and suggestions for improving the Student Health center. What did we do well? Where can we improve? Please give date of service. |
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15) OPTIONAL So that we may follow-up on your comments / suggestions, please provide the following information. It will remain confidential and within the Student Health Center. Thank you. |
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Name:
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Phone:
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Address:
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