Heshmatie Hospital
Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.
Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.
Thank you for your time.
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Your Age:
*
Your Country:
*
Your Sex: male Female
Full Name:(Optional)
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Please circle how well you
think we are doing in the
following areas:
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GREAT
5
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GOOD
4 |
OK
3 |
FAIR
2
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POOR
1
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Ease of getting care:
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Ability to get in to be seen
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Hours Center is open
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| Convenience of Center’s location |
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| Prompt return on calls |
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Waiting:
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Time in waiting room
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| Time in exam room |
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| Waiting for tests to be performed |
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| Waiting for test results |
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| Staff: Provider: (Physician, Dentist, Physician Assistant, Nurse Practitioner) |
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| Listens to you |
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Takes enough time with you
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| Explains what you want to know |
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| Gives you good advice and treatment |
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Nurses and Medical Assistants:
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| Friendly and helpful to you |
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Answers your questions
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Please circle how well you
think we are doing in the following areas:
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All Others:
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| Friendly and helpful to you |
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Payment :
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| What you pay |
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| Explanation of charges |
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| Collection of payment/money |
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Facility:
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| Neat and clean building |
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| Ease of finding where to go |
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| Comfort and Safety while waiting |
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| Privacy |
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Confidentiality:
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Keeping my personal information
private
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| Do you consider this center your regular source of care? |
Yes |
No
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What do you like best about our center?
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What do you like least about our Center?
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Suggestions for improvement?
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Sabzevar Heshmatie Hospital
