Your InformationStep 1 of 1

General Information

Please take a few minutes to answer this survey about your visit today. Responses are anonymous and reviewed by our Quality Assurance/ Performance Improvement (QA/PI) Committee.

Please rate the following statements:

Strongly DisagreeDisagreeNeutralAgreeStrongly AgreeNot Applicable
1. It was easy to schedule an appointment when I needed it.
My total wait time in the reception area and exam room was reasonable.
If I needed an interpreter, translation services, or cultural assistance today, it was readily available.
Strongly DisagreeDisagreeNeutralAgreeStrongly AgreeNot Applicable
1. Everyone I encountered- from check-in to check-out- showed friendliness and caring concern.
2. Staff members identified themselves and clearly explained what they would be doing for me.
3. I felt my personal and medical privacy was respected and protected during check-in and checkout.
Strongly DisagreeDisagreeNeutralAgreeStrongly AgreeNot Applicable
1. My Medical/ Dental Practitioner was willing to listen and respond to my specific questions or concerns.
2. My Medical/ Dental Practitioner explained my treatment, care plans, or medications in a way I could understand to help me make decisions about my care.
3. The healthcare team clearly explained my follow-up care, specialized referrals, or next steps with me.
Strongly DisagreeDisagreeNeutralAgreeStrongly AgreeNot Applicable
1. The hours of clinic operation are convenient for me and my family.
2. The overall comfort, cleanliness, and layout of the facility met my expectations.
3. Overall, I am highly satisfied with the quality of care I received today.

E. TELL US ABOUT YOUR VISIT!

What did we do well today? If a staff member made your visit great, please give them a shout out! We also welcome any ideas on how we can make your next visit better.