PATIENT SATISFACTION SURVEY (MEDICAL)

At UMC, we value your opinion regarding the care and treatment you received at our clinics. The feedback we obtain is used to make changes and improvements within our system. Please take a moment to tell us how we are doing by completing the survey on this page. Our goal is to provide the highest quality standards in a customer friendly environment. Thank you for taking the time to complete this survey.

Today's Date

Is this your first visit with us?
YesNo

What provider did you see today?

How did you get to today's appointment?

How did you hear about us or the other services we provide?
Newspaper(specify which one below)Radio(specify which one below)FacebookOur WebsitePatient/Staff Member(specify who below)Other(specify below)

Please circle the applicable rating for each question

Length of time on the phone while making an appointment.
ExcellentGoodFairPoor

Length of time from the day you made your appointment to the day of your appointment.
ExcellentGoodFairPoor

Length of time you were in the clinic.
ExcellentGoodFairPoor

Front Desk - Friendly and Respectful (phones, check-in, records)
ExcellentGoodFairPoor

Medical Assistants - Friendly and Respectful
ExcellentGoodFairPoor

Navigation/Referrals - Friendly and Respectful
ExcellentGoodFairPoor

Billing and Collections - Friendly and Respectful
ExcellentGoodFairPoor

Your Provider explained your treatment and answered your questions.
ExcellentGoodFairPoor

Your Provider showed interest in you as a patient.
ExcellentGoodFairPoor

Your Provider spent enough time with you.
ExcellentGoodFairPoor

Your privacy and confidentiality were respected.
ExcellentGoodFairPoor

Your financial situation was considered.
ExcellentGoodFairPoor

The clinic was clean and well-kept.
ExcellentGoodFairPoor

What is your overall rating of your experience at the clinic today?
ExcellentGoodFairPoor

Would you recommend our services to your family and friends?
YesNo

Did it take more than one call to make this appointment today?
YesNo

If yes, how many calls?

1. In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?
Same Day1 Day2-3 Days4-7 Days7+ Days

2. In the last 12 months, how often did your provider explain things in a way that was easy to understand?
NeverSometimesUsuallyAlways

3. In the last 12 months, did anyone in this provider's office talk with you about specific goals for your health?
YesNo

4. Specialists are doctors such as surgeons, heart doctors, allergy doctors, skin doctors, oral surgeons, endodontists and other doctors who specialize in one are of health care. In the last 12 months, did you see a specialist for a particular oral health problem? If no, skip question 5
YesNo

5. In the last 12 months, how often did your provider seem informed and up-to-date about the care you got from specialists?
NeverSometimesUsuallyAlways

6. Do you feel that the Uncompahgre Medical Center's hours meet your needs?
YesNo

7. Do you have insurance? If Yes, skip to question 8
YesNo

If No to question 7, were you made aware of out Sliding Fee Scale?
YesNo

8. Do you have CICP or UMC Sliding Fee? If No, skip to comment section below.
YesNo

If Yes to question 8, have you ever delayed care or postponed a visit to Uncompahgre Medical Center due to the inability to pay the nominal fee(CoPay)
YesNo

If Yes to question 8, do you feel the fee you are being charged for today's visit is fair for the quality and services provided by Uncompahgre Medical Center
YesNo

How could we improve?

What do we do well?

Would you like to recognize someone who exceeded your expectations?

If you have any feedback or concerns that you would like to discuss, please call (970) 327-4233. THANK YOU!