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Kimball Health Services

Survey - Rural Health Clinic

Kimball Health Services wants to provide the best possible service to you, our patient. Please help us better serve you by completing the survey. Feel free to express your opinions frankly.
After each statement, please mark the letter which reflects your satisfaction/opinion.
Excellent=E, Good=G, Fair=F, Poor=P
Accessibility
* Ease
Ease of reaching the appropriate person by telephone.
E     G     F     P    
* Timeliness/Promptness
Timeliness/promptness in which your telephone call was handled.
E     G     F     P    
B. Reception
* Questions
Questions answered satisfactorily:
E     G     F     P    
* Courtesy
Courtesy of the receptionist(s):
E     G     F     P    
* Efficiency
Efficiency of check-in process:
E     G     F     P    
* Financial Responsibility
Financial responsibility was clearly explained to me at check-in:
E     G     F     P    
* Reading Material
Variety of reading material available in front waiting room.
E     G     F     P    
C. Facility
* Appearance
Appearance/Cleanliness:
E     G     F     P    
* Convenience
Convenience of our Clinic location in the hospital:
E     G     F     P    
* Hours
Convenience of Clinic hours:
E     G     F     P    
D. Clinical Staff
* Courtesy
Courtesy and friendliness of our Medical Assistants and Nursing Staff:
E     G     F     P    
* Provider
Courtesy and friendliness of the provider you saw (physician or physician assistant)
E     G     F     P    
* Medical Staff
Do you feel that the medical staff took your health problem(s) seriously?
E     G     F     P    
* Time
Length of time you waited to be seen by the provider:
E     G     F     P    
* Wait
How long do you recall waiting before the provider entered the exam room?
5 min.     10min.     15min.     20min.     30min.    
  Comments
List any comments regarding the nursing staff:
* Explanation
Provider explanation of your problem and treatment:
E     G     F     P    
* Quality
Quality of care provided to you by clinic staff:
E     G     F     P    
* Follow-up
My follow-up instructions were communicated clearly.
E     G     F     P    
  Comments
List comments regarding the provider you saw:
* Provider
Please indicate the name of the provider you saw at this visit:
E. Final Ratings
* Test Results
How well were test results from past Clinic visits communicated to you:
E     G     F     P    
* Satisfaction
Satisfaction with the number of services offered at the Clinic:
E     G     F     P    
* Level of care
Overall satisfaction with the level of care you received:
E     G     F     P    
* Manner
Satisfaction with the manner in which your billing and insurance questions were handled:
E     G     F     P    
  Comments
List any comments you might have:
* Visit
Was this your first visit to our Clinic?
yes     no    
* Reccommend
Would you reccommend our Clinic to others?
yes     no    
* Pleasing?
Was there any particular thing or person who made your visit especially pleasing?
  Handouts (if applicable)
If you received patient education handouts, how helpful did you find them?
E     G     F     P