Mid-Delta Health Systems Patient Satisfaction Survey

Mid-Delta Health Systems Patient Satisfaction Survey

Please fill out this survey regarding your visit today. We appreciate you taking the time to help us improve your patient experience.
Date of Appointment

MonthDayYear
Date
Age of Patient
Please choose your provider

Dr. Curtis SchalchlinDr. Jennifer KellyDr. Thomas Patten, DentistDr. Wallace TracyDr. Chris HopkinsonHaley Ligon, APRNNancy Hornsby, APRNAshley Loftis, PALaura Hannum, APRNLauren Moore, APRNSkylar Vanderburg, APRNAlison Davis, RDH
On a scale of 1 – 5, 1 being very poor and 5 being very good, how would you rate each of the following:

Ease of making appointment by phone:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Ease of getting care and ability to be seen:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Hours of operation are reasonable:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Reasonable waiting time:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Coordinating your care to the proper specialists and/or resources needed in adequate time:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Provider’s ability to listen to what you say and to feel like you are a part of your healthcare decision:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Getting a question answered during and after clinic hours:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Behavioral Health Services:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Nurses/Dental Assistants:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Lab/X-Ray Technician:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Front Desk Staff:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Neat and clean building:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Fees for services reasonable and affordable:

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good

Information provided to you in a way that is understandable: (printed materials, interpretation service, etc.)

	0	1	2	3	4	5

0 is Very Poor, 5 is Very Good