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North Big Horn Hospital District

Patient Satisfaction Clinic Survey

Your feedback is important.  Please take a few minutes to let us know how we can better service you and your family.
Questions marked with an asterisk (*) are mandatory.

The information you provide is protected and secure.
  Date of Service
  Who was the provider you saw this visit?
* How would you rate the ease of scheduling your appointment?
* How would you rate the friendliness/responsiveness of registration staff?
* Did you feel like your wait time was appropriate to see the doctor?
* Did the care provider listen to what you had to say?
* Did the provider treat you with dignity and respect?
* Did our staff and provider respect and maintain your privacy?
* Did you get as much information about your condition and treatment as you wanted from the care provider?
* Using any number from 1 to 10, where 1 is the worst service possible and 10 is the best service possible, what number would you use to rate the Clinic’s service? 1     2     3     4     5     6     7     8     9     10    
  Is there a particular staff member who made an impression on you, good or bad, that you would like to tell us about?
  Please feel free to make any suggestions that you feel could improve our service to you.