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?
 Yes No

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) Facebook Our Website Patient/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.
 Excellent Good Fair Poor

Length of time from the day you made your appointment to the day of your appointment.
 Excellent Good Fair Poor

Length of time you were in the clinic.
 Excellent Good Fair Poor

Front Desk - Friendly and Respectful (phones, check-in, records)
 Excellent Good Fair Poor

Medical Assistants - Friendly and Respectful
 Excellent Good Fair Poor

Navigation/Referrals - Friendly and Respectful
 Excellent Good Fair Poor

Billing and Collections - Friendly and Respectful
 Excellent Good Fair Poor

Your Provider explained your treatment and answered your questions.
 Excellent Good Fair Poor

Your Provider showed interest in you as a patient.
 Excellent Good Fair Poor

Your Provider spent enough time with you.
 Excellent Good Fair Poor

Your privacy and confidentiality were respected.
 Excellent Good Fair Poor

Your financial situation was considered.
 Excellent Good Fair Poor

The clinic was clean and well-kept.
 Excellent Good Fair Poor

What is your overall rating of your experience at the clinic today?
 Excellent Good Fair Poor

Would you recommend our services to your family and friends?
 Yes No

Did it take more than one call to make this appointment today?
 Yes No

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 Day 1 Day 2-3 Days 4-7 Days 7+ Days

2. In the last 12 months, how often did your provider explain things in a way that was easy to understand?
 Never Sometimes Usually Always

3. In the last 12 months, did anyone in this provider's office talk with you about specific goals for your health?
 Yes No

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
 Yes No

5. In the last 12 months, how often did your provider seem informed and up-to-date about the care you got from specialists?
 Never Sometimes Usually Always

6. Do you feel that the Uncompahgre Medical Center's hours meet your needs?
 Yes No

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!