Sheridan Memorial Rural Health Clinic Services Survey

Question Title

* 1. Which provider did you see?

Carlos Trevino, MD

David Shahbodaghi, MD

Kelsey Haugo, FNP

Brit Nyby, PA-C

Jennifer Hoversland, FNP

Stephanie Kanning, FNP

Elizabeth Kleppen, PA

Other (please specify)

	Very Good	Good	Fair	Poor	Very Poor	N/A
Receptionists	Receptionists Very Good	Receptionists Good	Receptionists Fair	Receptionists Poor	Receptionists Very Poor	Receptionists N/A
Nurses/Clinical Staff	Nurses/Clinical Staff Very Good	Nurses/Clinical Staff Good	Nurses/Clinical Staff Fair	Nurses/Clinical Staff Poor	Nurses/Clinical Staff Very Poor	Nurses/Clinical Staff N/A
Providers: MD, FNP, PA	Providers: MD, FNP, PA Very Good	Providers: MD, FNP, PA Good	Providers: MD, FNP, PA Fair	Providers: MD, FNP, PA Poor	Providers: MD, FNP, PA Very Poor	Providers: MD, FNP, PA N/A
Office Staff/Billing Services	Office Staff/Billing Services Very Good	Office Staff/Billing Services Good	Office Staff/Billing Services Fair	Office Staff/Billing Services Poor	Office Staff/Billing Services Very Poor	Office Staff/Billing Services N/A

Very Good

Good

Fair

Poor

Very Poor

N/A

Receptionists

Receptionists Very Good

Receptionists Good

Receptionists Fair

Receptionists Poor

Receptionists Very Poor

Receptionists N/A

Nurses/Clinical Staff

Nurses/Clinical Staff Very Good

Nurses/Clinical Staff Good

Nurses/Clinical Staff Fair

Nurses/Clinical Staff Poor

Nurses/Clinical Staff Very Poor

Nurses/Clinical Staff N/A

Providers: MD, FNP, PA

Providers: MD, FNP, PA Very Good

Providers: MD, FNP, PA Good

Providers: MD, FNP, PA Fair

Providers: MD, FNP, PA Poor

Providers: MD, FNP, PA Very Poor

Providers: MD, FNP, PA N/A

Office Staff/Billing Services

Office Staff/Billing Services Very Good

Office Staff/Billing Services Good

Office Staff/Billing Services Fair

Office Staff/Billing Services Poor

Office Staff/Billing Services Very Poor

Office Staff/Billing Services N/A

	Very Good	Good	Fair	Poor	Very Poor	N/A
Convenience of office hours.	Convenience of office hours. Very Good	Convenience of office hours. Good	Convenience of office hours. Fair	Convenience of office hours. Poor	Convenience of office hours. Very Poor	Convenience of office hours. N/A
Comfort of reception area.	Comfort of reception area. Very Good	Comfort of reception area. Good	Comfort of reception area. Fair	Comfort of reception area. Poor	Comfort of reception area. Very Poor	Comfort of reception area. N/A
Comfort of exam rooms.	Comfort of exam rooms. Very Good	Comfort of exam rooms. Good	Comfort of exam rooms. Fair	Comfort of exam rooms. Poor	Comfort of exam rooms. Very Poor	Comfort of exam rooms. N/A

Very Good

Good

Fair

Poor

Very Poor

N/A

Convenience of office hours.

Convenience of office hours. Very Good

Convenience of office hours. Good

Convenience of office hours. Fair

Convenience of office hours. Poor

Convenience of office hours. Very Poor

Convenience of office hours. N/A

Comfort of reception area.

Comfort of reception area. Very Good

Comfort of reception area. Good

Comfort of reception area. Fair

Comfort of reception area. Poor

Comfort of reception area. Very Poor

Comfort of reception area. N/A

Comfort of exam rooms.

Comfort of exam rooms. Very Good

Comfort of exam rooms. Good

Comfort of exam rooms. Fair

Comfort of exam rooms. Poor

Comfort of exam rooms. Very Poor

Comfort of exam rooms. N/A

	Very Good	Good	Fair	Poor	Very Poor	N/A
How were you treated when you last telephoned our office?	How were you treated when you last telephoned our office? Very Good	How were you treated when you last telephoned our office? Good	How were you treated when you last telephoned our office? Fair	How were you treated when you last telephoned our office? Poor	How were you treated when you last telephoned our office? Very Poor	How were you treated when you last telephoned our office? N/A
How were you treated by the registration staff at the time of your visit?	How were you treated by the registration staff at the time of your visit? Very Good	How were you treated by the registration staff at the time of your visit? Good	How were you treated by the registration staff at the time of your visit? Fair	How were you treated by the registration staff at the time of your visit? Poor	How were you treated by the registration staff at the time of your visit? Very Poor	How were you treated by the registration staff at the time of your visit? N/A
How were you treated when making a follow up appointment?	How were you treated when making a follow up appointment? Very Good	How were you treated when making a follow up appointment? Good	How were you treated when making a follow up appointment? Fair	How were you treated when making a follow up appointment? Poor	How were you treated when making a follow up appointment? Very Poor	How were you treated when making a follow up appointment? N/A
Regarding your account, how were you treated by the billing staff?	Regarding your account, how were you treated by the billing staff? Very Good	Regarding your account, how were you treated by the billing staff? Good	Regarding your account, how were you treated by the billing staff? Fair	Regarding your account, how were you treated by the billing staff? Poor	Regarding your account, how were you treated by the billing staff? Very Poor	Regarding your account, how were you treated by the billing staff? N/A
How would you rate the billing statements. Are they easy to read and understand?	How would you rate the billing statements. Are they easy to read and understand? Very Good	How would you rate the billing statements. Are they easy to read and understand? Good	How would you rate the billing statements. Are they easy to read and understand? Fair	How would you rate the billing statements. Are they easy to read and understand? Poor	How would you rate the billing statements. Are they easy to read and understand? Very Poor	How would you rate the billing statements. Are they easy to read and understand? N/A

Very Good

Good

Fair

Poor

Very Poor

N/A

How were you treated when you last telephoned our office?

How were you treated when you last telephoned our office? Very Good

How were you treated when you last telephoned our office? Good

How were you treated when you last telephoned our office? Fair

How were you treated when you last telephoned our office? Poor

How were you treated when you last telephoned our office? Very Poor

How were you treated when you last telephoned our office? N/A

How were you treated by the registration staff at the time of your visit?

How were you treated by the registration staff at the time of your visit? Very Good

How were you treated by the registration staff at the time of your visit? Good

How were you treated by the registration staff at the time of your visit? Fair

How were you treated by the registration staff at the time of your visit? Poor

How were you treated by the registration staff at the time of your visit? Very Poor

How were you treated by the registration staff at the time of your visit? N/A

How were you treated when making a follow up appointment?

How were you treated when making a follow up appointment? Very Good

How were you treated when making a follow up appointment? Good

How were you treated when making a follow up appointment? Fair

How were you treated when making a follow up appointment? Poor

How were you treated when making a follow up appointment? Very Poor

How were you treated when making a follow up appointment? N/A

Regarding your account, how were you treated by the billing staff?

Regarding your account, how were you treated by the billing staff? Very Good

Regarding your account, how were you treated by the billing staff? Good

Regarding your account, how were you treated by the billing staff? Fair

Regarding your account, how were you treated by the billing staff? Poor

Regarding your account, how were you treated by the billing staff? Very Poor

Regarding your account, how were you treated by the billing staff? N/A

How would you rate the billing statements. Are they easy to read and understand?

How would you rate the billing statements. Are they easy to read and understand? Very Good

How would you rate the billing statements. Are they easy to read and understand? Good

How would you rate the billing statements. Are they easy to read and understand? Fair

How would you rate the billing statements. Are they easy to read and understand? Poor

How would you rate the billing statements. Are they easy to read and understand? Very Poor

How would you rate the billing statements. Are they easy to read and understand? N/A

	Very Good	Good	Fair	Poor	Very Poor	N/A
How would you rate the nurse or clinical assistant as being professional and courteous?	How would you rate the nurse or clinical assistant as being professional and courteous? Very Good	How would you rate the nurse or clinical assistant as being professional and courteous? Good	How would you rate the nurse or clinical assistant as being professional and courteous? Fair	How would you rate the nurse or clinical assistant as being professional and courteous? Poor	How would you rate the nurse or clinical assistant as being professional and courteous? Very Poor	How would you rate the nurse or clinical assistant as being professional and courteous? N/A
Provider's explanation of your condition, test and treatment.	Provider's explanation of your condition, test and treatment. Very Good	Provider's explanation of your condition, test and treatment. Good	Provider's explanation of your condition, test and treatment. Fair	Provider's explanation of your condition, test and treatment. Poor	Provider's explanation of your condition, test and treatment. Very Poor	Provider's explanation of your condition, test and treatment. N/A
Reporting of the test results.	Reporting of the test results. Very Good	Reporting of the test results. Good	Reporting of the test results. Fair	Reporting of the test results. Poor	Reporting of the test results. Very Poor	Reporting of the test results. N/A
Willingness of provider to answer your questions.	Willingness of provider to answer your questions. Very Good	Willingness of provider to answer your questions. Good	Willingness of provider to answer your questions. Fair	Willingness of provider to answer your questions. Poor	Willingness of provider to answer your questions. Very Poor	Willingness of provider to answer your questions. N/A
If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was?	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Very Good	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Good	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Fair	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Poor	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Very Poor	If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? N/A

Very Good

Good

Fair

Poor

Very Poor

N/A

How would you rate the nurse or clinical assistant as being professional and courteous?

How would you rate the nurse or clinical assistant as being professional and courteous? Very Good

How would you rate the nurse or clinical assistant as being professional and courteous? Good

How would you rate the nurse or clinical assistant as being professional and courteous? Fair

How would you rate the nurse or clinical assistant as being professional and courteous? Poor

How would you rate the nurse or clinical assistant as being professional and courteous? Very Poor

How would you rate the nurse or clinical assistant as being professional and courteous? N/A

Provider's explanation of your condition, test and treatment.

Provider's explanation of your condition, test and treatment. Very Good

Provider's explanation of your condition, test and treatment. Good

Provider's explanation of your condition, test and treatment. Fair

Provider's explanation of your condition, test and treatment. Poor

Provider's explanation of your condition, test and treatment. Very Poor

Provider's explanation of your condition, test and treatment. N/A

Reporting of the test results.

Reporting of the test results. Very Good

Reporting of the test results. Good

Reporting of the test results. Fair

Reporting of the test results. Poor

Reporting of the test results. Very Poor

Reporting of the test results. N/A

Willingness of provider to answer your questions.

Willingness of provider to answer your questions. Very Good

Willingness of provider to answer your questions. Good

Willingness of provider to answer your questions. Fair

Willingness of provider to answer your questions. Poor

Willingness of provider to answer your questions. Very Poor

Willingness of provider to answer your questions. N/A

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was?

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Very Good

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Good

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Fair

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Poor

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? Very Poor

If you have called the nurse, clinical assistant or provider with question, how do you feel the response time was? N/A

Question Title

* 6. Overall Care at Sheridan Memorial Clinic

	Very Good	Good	Fair	Poor	Very Poor	N/A
Overall professionalism and care at our facility.	Overall professionalism and care at our facility. Very Good	Overall professionalism and care at our facility. Good	Overall professionalism and care at our facility. Fair	Overall professionalism and care at our facility. Poor	Overall professionalism and care at our facility. Very Poor	Overall professionalism and care at our facility. N/A

Comments:

Sheridan Memorial Rural Health Clinic Services

440 West Laurel Avenue Plentywood, MT 59254

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* 1. Which provider did you see?

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* 2. How would you rate the confidentiality of:

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* 3. How would you rate the following?

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* 4. Please rate our Reception and Office Staff

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* 5. Please rate our Providers, Nurses and Clinical Assistants

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* 6. Overall Care at Sheridan Memorial Clinic

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* 7. Would you recommend the facility to others?

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* 8. What one thing do you most like about our practice?

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* 9. How can we improve our service?