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Minnie Hamilton Health System - Survey

Patient Satisfaction Survey

1. Please indicate the location of your visit:

Grantsville Clinic	Arnoldsburg Clinic	Glenville Clinic
Grantsville Clinic	Arnoldsburg Clinic	Glenville Clinic

2. Convenience of location for you?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

3. Convenience of hours of operation?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

4. How easy was it to schedule a visit with us?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

5. Treatment of confidential information by staff was:

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

6. Please rate the cleanliness of your exam room

Excellent (Very Clean)	Very Good (Mostly Clean)	Good (Clean)	Fair (Needs improvement)	Poor (Unacceptable)	Not Applicable (N/A)	Not Answered
Excellent (Very Clean)	Very Good (Mostly Clean)	Good (Clean)	Fair (Needs improvement)	Poor (Unacceptable)	Not Applicable (N/A)	Not Answered

7. Length of wait time?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

8. How would you rate the way your financial arrangements were handled?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

9. Did staff follow appropriate hand washing guidelines?

Yes	No	Unsure	Not Applicable (N/A)	Not Answered
Yes	No	Unsure	Not Applicable (N/A)	Not Answered

10. Did your provider have a good understanding of your medical history?

Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered
Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered

11. Did your provider listen to you carefully?

Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered
Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered

12. Did the provider talk with you about specific goals for your health?

Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered
Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered

13. How would you rate the courtesy of our staff?

Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered
Excellent (fully met my needs)	Very Good (mostly met my needs)	Good (met my needs)	Fair (partially met my needs)	Poor (did not meet my needs)	Not Applicable (N/A)	Not Answered

14. Did the provider explain what to do if your condition gets worse?

Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered
Yes, definitely	Yes, somewhat	No	Not Applicable (N/A)	Not Answered

15. Would you recommend this health center to others?

Yes	No	Not answered
Yes	No	Not answered

16. Please indicate the name of the provider you saw during your visit today.

17. Please indicate the following for the person seen by the provider today:

Male	Female	Not answered
Male	Female	Not answered

18. Please indicate your age range:

Under 18	18-24	25-34	34-44	45 or older	Not Answered
Under 18	18-24	25-34	34-44	45 or older	Not Answered

19. How was your visit paid for?

Medicare	Medicaid	Insurance	Self-Pay	45 or older	Worker's Comp	HMO	Not Answered
Medicare	Medicaid	Insurance	Self-Pay	45 or older	Worker's Comp	HMO	Not Answered

21. Did registration staff ask for updated information (Photo ID, insurance, address, etc.)?

Yes	No	Not answered
Yes	No	Not answered

22. Was the registration staff courteous?

Yes	No	Not answered
Yes	No	Not answered

23. Please use the space below to address any questions, comments or concerns with your visit. If you would like us to follow up, please include your contact information.