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GIVE US A GRADE (Patient Satisfaction Questionnaire)

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Please "give us a grade" on each of the following areas of Student Health Services (SHS) that you have EXPERIENCED during your recent visit(s) to SHS. This is an anonymous survey and your response cannot be traced to any identifying information.

Select your best answer but please leave unanswered those areas that are not applicable. When you are finished, hit the "Submit" button at the end of the survey.

Please indicate the day(s) of service for which you are grading: *
THE FACILITY:

Easy to find:

Patient parking accessible:
Clean lobby and rooms:
Finding your way around:
Your comfort while here:
Protection of your privacy:
THE APPOINTMENT PROCESS:

Getting an appointment:

Politeness of the appointment person:
Telephone service:
WAITING TIME:

At the reception window:

In the waiting room:
In the examining room:
At the laboratory:
At X-ray:
At the Pharmacy:
What do you consider a long time to wait ? (in minutes):
YOUR DOCTOR OR NURSE PRACTITIONER:

Understood what you said:

Took enough time with you:
Was careful and helpful:
Taught you about your condition:
Told you what your lab and/or X-ray tests were for:
Told you what your prescriptions or medications were for:
OVERALL ASSESSSMENT:

Was your reason for coming taken care of to your satisfaction?:

Did you fully understand your condition?:
If medication was prescribed, did you understand the directions before you left SHS?:
Would you recommend SHS to others?:
OVERALL SATISFACTION WITH STAFF:

Receptionist(s):

Nurse(s):
Physician(s):
Nurse Practitioner(s):
Health Educator(s):
Lab Technician(s):
Pharmacist(s):
X-Ray Technician:
Administrative or Office Personnel:
DEMOGRAPHIC INFORMATION:

What is your gender?:

What is your age?:
What is your ethnicity?:
College of Major:
Class Level:
Do you live on campus?:
How did you first learn about Student Health Services?: *
Do you think the services at SHS are important in supporting your academic success at Cal Poly Pomona?:
What did you learn from your visit(s) that would help you to live a healthier lifestyle?:
What additional services would like to see at SHS?:
Please feel free to add additional comments:

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