Updated Patient Satisfaction Survey English

Patient Satisfaction Survey

Thank you for taking our survey. If you cannot answer these questions yourself, you can ask someone you trust to help you. We encourage you to be honest with your answers. Your answers are confidential and will never be personally identified. Your responses will be shared in an anonymous form with your care team and others to improve the quality of your patient experience.
1. How long have you been going to PCC Community Wellness Center (PCC)?

This was my first visit to this practiceLess than 6 monthsBetween 6 months and 1 yearBetween 1 and 3 yearsBetween 3 and 5 years5 years or longer
2. Can you please confirm the reason for your visit?

Wellness or annual visitVisit for a new condition or issueFollow-up visit for an existing condition or issueVisit to get a second opinionPre-surgeryappointmentVisit after hospital dischargeFollow-up after surgeryUnscheduled/walk-inOther

3. Please rate how well your provider did in the following areas during your visit:

	Excellent	Very Good	Somewhat Satisfied	Fair	Poor
Providing details about new medications prescribed
Informing you about any necessary follow-up care
Being aware of care you received from other doctors/providers
Spending as much time with you as you feel you need
Involving you in making decisions about your health
Balancing personal interaction with you while using a laptop or computer
Listening carefully and respectfully to you
Explaining things in a way that is easy to understand

4. Using a scale from 0 to 10, how would you rate your Provider?

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

5. Using a scale from 0 to 10, how likely would you be to recommend your Provider to others?

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

6. Please provide any additional comments you would like to make concerning your Provider:
7. How many minutes did you wait between your scheduled appointment time and when you were seen by your doctor or Provider?

5 minutes or less6 – 15 minutes16 – 30 minutes31-45 minutesOver 45 minutes

8. Please rate PCC Community Wellness Center in each area for your visit today:

	Excellent	Very Good	Somewhat Satisfied	Fair	Poor
Having a comfortable and pleasant waiting area
Ability to communicate with the practice on the phone
Ease of scheduling this appointment
Being informed about any delays during this visit
Maintaining patient privacy throughout this visit

9. Please tell us how much you agree or disagree with each statement about your visit:

	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree
The doctors, nurses, and staff did a good job coordinating care during my visit.
Check-in and check-out staff was respectful and courteous.
Phone and scheduling staff were respectful and courteous.
Each member of my care team identified themselves and their role in my care.
Nursing staff was respectful and courteous.
The staff clearly explained the details of any procedures.
The practice worked with my other providers to coordinate my care effectively.
PCC helps me make healthy lifestyle choices.
I was able to make a same-day appointment when sick or hurt.
The health center hours work for me.
The amount I was charged was reasonable based on services received.
I am aware that PCC offers dental and behavioral health services.

10. Using a scale from 0 to 10, how likely would you be to recommend PCC Community Wellness Center to others?

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

11. Please provide any additional comments you would like to make concerning PCC Community Wellness Center.
12. Which health center did you go to for this visit?

PCC Austin Family Health CenterPCC Clinic at The BoulevardPCC Community Wellness Center at SteinmetzPCC Community Wellness Center at West SuburbanPCC Dr. Tong Center Family Health CenterPCC Lake Street Family Health CenterPCC Melrose Park Family Health CenterPCC Salud Family Health CenterPCC South Family Health CenterPCC Walk-In Wellness Center at West Suburban Medical CenterPCC West Town Family Health CenterI'm not sureOther
13. What is the name of the provider you saw today? (Optional)
14. Would you like to be contacted by a PCC staff member to discuss your experience?

YesNo
If yes, please include your name and contact information below (optional):
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Enter the message as it's shown*
Thank you for completing our survey! Your input is extremely important to us.
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