Patient Survey
Note
To protect you, your family's, or your patient's privacy, please DO NOT include any Personally Identifiable Information (PII) or Protected Health Information (PHI) on this form. Examples of PII and PHI are: personal phone number(s), personal address, individual health condition(s), Social Security number (SSN), date of birth (DOB), patient name (if not your own), and patient registration number. For more information regarding PII and PHI, please visit the Privacy Policy and HIPAA pages.
These survey responses are reviewed on sporadic basis, generally every 4 weeks. As such, this venue is not appropriate to have individual needs, concerns, complaints, or grievances addressed. For complaints or grievances that require a response, please contact your service unit directly for process and procedures.
From your perspective as a patient, we ask you to answer questions that will help our Quality Improvement Team understand how we can improve our service to you and others who come to our clinic. The survey takes only a few minutes. Please select the answer that best describes your experience with the care you received today. We welcome your comments and suggestions about how we can provide better care. Your responses and participation are kept confidential and will not be connected to you. If you have questions or need assistance, just ask - our staff is ready to help you.
