Patient Satisfaction Survey
Clinic

1.)* I received services from Central Valley Medical Center's Medical Clinic on:

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2006 2005

2.)* I was a Patient Caregiver Visitor at Fountain Green Nephi .

3.)* The person who provided care was:   Richard Anderson, M.D. Stanton Bailey, M.D. James Besendorfer, M.D. Molly Brotherson, PA-C Brian Gasser, FNP Christy Mangelson, FNP David McClain, M.D. Mark Oveson, M.D. Michael Peterson, M.D. Grant Rasmussen, M.D. Jerald Taylor, D.O.

4.)* The appointment was:   Scheduled A Walk-in

5.)* If the appointment was scheduled, about how long did you have to wait (in the reception area and the exam room) before seeing the provider?   >45 minutes 35 - 45 minutes 20 - 30 minutes 10 - 15 minutes < 5 minutes

6.)* The office staff is   Rarely or never Sometimes About half of the time Most of the time Always   friendly, courteous and helpful.

7.)* The medical assistants and nurses are   Rarely or never Sometimes About half of the time Most of the time Always   sensitive and treat me with respect.

On a scale of 1 to 5 please rate the care you/your child/loved one received while at our clinic. (1 being very poor and 5 being excellent)

8.)* How would you rate how well the medical provider listened to what you had to say?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


9.)* How would you rate how well the medical provider answered your questions?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


10.)* How would you rate how well the medical provider offered advice on ways you can avoid illness and stay healthy?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


11.)* How would you rate how well the medical provider explained your diagnosis in a way you could understand?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


12.)* How would you rate the ease of accessing a specialist, if needed?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


13.)* How would you rate the ease of accessing emergency care, if needed?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


14.)* How would you rate the follow-up on medical procedures or test results, if performed?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


15.)* How would you rate the way questions regarding your bill are answered?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


16.)* How would you rate the cleanliness of the clinic waiting room, reception area, and exam rooms?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


17.)* How would you rate the overall quality of care you received at the clinic?

     1. Very Poor       2. Poor       3. Fair       4. Good       5. Excellent  


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