Patient Satisfaction Survey
We ask your assistance in assessing the quality of care you received. Your comments will be used in our continuing efforts to improve the quality of service to all patients.
 
1. Please answer the following to let us know why you have chosen University Specialty Clinics:
Personal Choice Physician Referral
Friend/Relative Referral Newspaper Advertising
Yellow Pages Directory Advertising Managed Care Plan Referral or Directory
Nurse Practitioner
2. From which of our clinical units did you receive your care?
Family Medicine Internal Medicine
Neuropsychiatry Ob/Gyn
Ophthalmology Orthopaedics
Pediatrics Surgery
University Primary Care Faculty/Staff Clinic
Children and Family Healthcare Center Women and Family Healthcare Center
Primary Care Partners
3.Which Physician/ Nurse Practitioner did you see today?
4. Please Rate the Following Questions using this Scale: 1. excellent 2. very good 3. good  4. fair 5. poor
Appointment Process
No difficulty with appointment 1 2 3 4 5 
Treated courteously 1 2 3 4 5
5. Please Rate the Following Questions using this Scale: 1. excellent 2. very good 3. good  4. fair 5. poor
Staff (Physicians, Nurse Practitioners, Nurses, Support Staff
Greeted and attended to promptly 1 2 3 4 5 
Office staff polite and helpful 1 2 3 4 5 
Nursing staff polite and helpful 1 2 3 4 5 
During visit physician/nurse practitioner adequately explained my illness and treatment options 1 2 3 4 5 
My physician/nurse practitioner took enough time with me, told me what I needed to know, and answered my questions thoroughly 1 2 3 4 5 
Waiting time to see my physician/nurse practitioner was reasonable 1 2 3 4 5 
Receptionist or nurse explained any delay in seeing my physician/nurse practitioner 1 2 3 4 5 
Billing and collection procedures were clearly explained 1 2 3 4 5 
6. Please Rate the Following Questions using this Scale: 1. excellent 2. very good 3. good  4. fair 5. poor
Facility
Easy to find 1 2 3 4 5 
Parking available 1 2 3 4 5 
Clean Building 1 2 3 4 5 
Rooms neat 1 2 3 4 5 
7. I would recommend this facility to a relative or friend
If NO, why?
8. Please Rate the Following Questions using this Scale: 1. excellent 2. very good 3. good  4. fair 5. poor
Overall Rating:
Physicians/Nurse Practitioners 1 2 3 4 5 
Nurses 1 2 3 4 5 
Support Staff 1 2 3 4 5 
Experience at the Office 1 2 3 4 5 
Overall Rating 1 2 3 4 5
9. Other comments, Suggestions, Questions.
This survey will be submitted anonymously. It is optional for you to include your name, address and phone number below.