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  1. Surveys
  2. 2013
  3. January
  4. E
  5. Evaluation of Health Services
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Exit Survey
 
 
Thank you for participating in this survey. In keeping with our mission of providing patient-centered quality health care, your opinion is important. Please take a few minutes to complete this anonymous survey regarding your visit today to our health center. This survey is intended to assist the office offering health services to Stockton students to assess the nature and quality of the services it offers. Data will be used for system wide analyses of health services offered to students. Your responses are anonymous and will remain confidential.
 
 
 
* How did you hear about Health Services? (Select any and all that apply.)
 
On campus/web literature
 
Friends
 
Referral from faculty/staff
 
Referral from Housing
 
Wellness Programs
 
Other (please specify)
 

 
 
 
* What is your University Status? (select any and all that apply.)
 
Freshman
 
Sophomore
 
Junior
 
Senior
 
Graduate Student
 
Live on campus
 
Live off campus/commuter
 
Other (please specify)
 

 
 
 
* Please indicate where you received care today.
 
Visit with Doctor
 
Visit with Nurse only
 
Planned Parenthood
 
Nutritionist
 
 
Please use the following scale to rate how satisfied you were with each of the following attributes of today's visit concerning your ability to schedule an appointment.
Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied N/A
* Convenience of appointment for Doctor (how convenient was the appointment time available)
* Wait time for appointment for Doctor (how soon could you be seen by the doctor)?
* Convenience of appointment for Planned Parenthood
* Wait time for appointment for Planned Parenthood
* The amount of time you had to wait to see the clinician after signing in for your appointment
 
 
Please use the following scale to rate how satisfied you were with each of the following attributes of today's visit concerning your experience with the receptionist staff.
Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
* Courtesy
* Promptness
* Response to Questions
 
 
Please use the following scale to rate how satisfied you were with each of the following attributes of today's visit concerning your experience with the Nursing staff and/or Doctor, or Planned Parenthood.
Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied N/A
* Nurse: Courtesy
* Nurse: Promptness
* Nurse: Response to Questions
* Nurse: Explanation of Procedures
* Nurse: Directions for follow-up care
* Doctor: Courtesy
* Doctor: Promptness
* Doctor: Response to Questions
* Doctor: Explanation of Procedures
* Doctor: Directions for follow up care
* Planned Parenthood: Courtesy
* Planned Parenthood: Promptness
* Planned Parenthood: Response to Questions
* Planned Parenthood: Explanation of Procedures
* Planned Parenthood: Directions for follow up care
 
 
Please use the following scale to rate how satisfied you were with each of the following attributes of today's visit concerning privacy and confidentiality.
Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
* When interacting with staff
* When examined by the clinician(s)
 
 
 
* Please indicate your overall level of satisfaction with the quality of services you received from our health center today.
 
Excellent
 
Good
 
Average
 
Fair
 
Poor
 
 
 
Do you have any suggestions about what might be done to improve Health Services?
   
 
Thank you for participating in our survey. When you are finished, please click 'Continue' and then click 'Home' in the upper right hand corner.