Northeastern Tribal Health System Patient Survey
*
1.
What department were you seen in today?
(Required.)
Medical/Pediatrics
Dental
Optometry
Diabetes/Wellness
Physical Therapy/Occupational Therapy
Radiology
Laboratory
Pharmacy
Other
Other (please specify)
*
2.
Pleas select the appropriate age range for yourself (the patient).
(Required.)
0-15, Please specify if you were seen in Pediatrics or the main Medical Department.
16-30
31-45
46-60
61-75
76+
0-15
3.
Appointment available within a reasonable time?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
4.
Overall efficiency of check-in process?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
5.
Wait time in the exam room?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
6.
If appointment was delayed, how well did we do at keeping you informed of the delay?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
7.
If a referral was required, how did we do at making the process easy for you?
Very satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
8.
Caring / Concern / Professionalism of the NTHS staff?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
9.
Phone calls are returned promptly?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
10.
Explanation of your health concerns / questions?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
11.
Test results available within a reasonable amount of time?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
12.
Clarity and effectiveness of the health information material provided?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
13.
Wait time for your in-clinic prescriptions to be filled?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
14.
Cleanliness of the clinic?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
15.
Overall satisfaction of care from your medical home provider?
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
16.
Suggestions for improvement: