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Patient Satisfaction Survey

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Your feedback is important to us!

Our goal is to provide quality affordable health care to you. Let us know how we are doing!

Please take a few moments to print out this page and fill out the form below. You can either drop it off at the front desk or mail it to us at:

Partnership Health Center
Patient Satisfaction
323 West Alder Street
Missoula, MT 59802

All answers are confidential and will not in any way effect your ability to access services at Partnership Health Center.

You can also open up this form up in Adobe Acrobat Reader. You can then circle and write your answers on the printed form.

Please correct the field(s) marked in red below:

1
The time of day of my visit was:
 *
The time of day of my visit was:

2
Ease of getting care:
 *
Ease of getting care:
Great Good Okay Fair Poor
Ability to get in to be seen:
Hours the Center is open:
Phone system:

3
Reception:
 *
Reception:
Great Good Okay Fair Poor
Time in reception area:
Comfort level of reception area:

4
Staff - Reception:
 *
Staff - Reception:
Great Good Okay Fair Poor
Friendly and helpful:
Takes enough time with you:
Explains what you want to know:

5
Staff - Nurses and medical assistants:
 *
Staff - Nurses and medical assistants:
Great Good Okay Fair Poor
Friendly and helpful to you:
Provider (physician, physician assistant, nurse practitioner):

6
Staff - Pharmacy:
 *
Staff - Pharmacy:
Great Good Okay Fair Poor
Friendly and helpful to you:
Answers your questions:

7
Payment:
 *
Payment:
Great Good Okay Fair Poor
Copay:
Explanation of charges:

8
Facility:
 *
Facility:
Great Good Okay Fair Poor
Neat and clean building:
Parking:

9
Confidentiality:
 *
Confidentiality:
Great Good Okay Fair Poor
Keeping my personal information private:

10
The likelihood of referring your friends and relatives to us:
 *
The likelihood of referring your friends and relatives to us:
Great Good Okay Fair Poor
Suggesting PHC to your friends and relatives

11
What do you like best about our center?
12
What do you like least about our center?
13
Has our recent change to Electronic Medical Recordkeeping improved your visit?
Has our recent change to Electronic Medical Recordkeeping improved your visit?

Thank you for completing our survey!

  1. To receive a copy of your submission, please fill out your email address below and submit.
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