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Surveys
2015
November
P
Patient satisfaction survey #3
Patient satisfaction survey #3
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Hello:
We need you help ! In order to give our patients the best healthcare we can we need to know what we need to improve upon and what we're doing right. Please take a few minutes to answer a few questions
Age ?
0-12 13-18 19-30 31-50 51-64 65 +
Gender ?
Male Female Other
Which provider do you see ?
Dr Depner Linda Pullman Brad Speta
Highest level of education completed ?
8th grade or less Some high school 12th grade GED
Some College College or Vocational Degree
Four year College More than four year College
How satisfied are you with the following:
Very Dissatisfied
Not Satisfied
Neutral
Satisfied
Very Satisfied
Ease of Scheduling routine appointments ?
Ability of being seen within 24 hours for illness/injury ?
Being treated with courtesy and respect ?
The knowledge of your provider about your health care ?
Did you have any other services ordered today ?
Labs
Radiology (x-rays ,ultrasounds,CT's MRI's,Mammograms,Dexa)
Referrals to a Specialist
How would you rate your health ?
Great
Good
Average
Fair
Poor
Overall Health
Physical health
Mental health
Which of the following hinders improvement to your health ?
Age
Lack of mobility
Lack of insurance/Inadequate insurance
Financial restraints
Lack of personal support/caregivers
Depression
Unknown
None of the above/No hindrances
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