La Sierra University: Health Services

At La Sierra University Student Health Service, we value your opinions regarding the service you receive. We strive to improve the service we offer and welcome your feedback and suggestions. Please take a few minutes to complete this survey and return it to us.
STUDENT HEALTH SERVICE Patient Satisfaction Survey
A. Availability of Care	Dissatisfied	Satisfied
1. Timely appointment scheduled	1 2 3 4 5
2. Notified of scheduled appointment change	1 2 3 4 5
3. Instructions given if appointment not available	1 2 3 4 5

B. Reception Area/Exam Rooms	Dissatisfied	Satisfied
1. Adequate seating/space	1 2 3 4 5
2. Cleanliness of reception area	1 2 3 4 5

C. Waiting Time	Dissatisfied	Satisfied
1. In reception area	1 2 3 4 5
2. In examination room	1 2 3 4 5
3. Notified of appointment delay	1 2 3 4 5

D. Customer Relations	Dissatisfied	Satisfied
1. Treated with courtesy & respect	1 2 3 4 5
2. Responsiveness to your concerns	1 2 3 4 5
3. Timely assistance provided	1 2 3 4 5

E. Professional Care by Physician	Dissatisfied	Satisfied
1. Questions answered by end of visit	1 2 3 4 5
2. Plan for treatment explained	1 2 3 4 5
3. Instructions given for follow-up	1 2 3 4 5

F. Professional Care by Staff	Dissatisfied	Satisfied
1. Questions answered by end of visit	1 2 3 4 5
2. Instructions given for follow-up	1 2 3 4 5
3. Follow-up call made by staff	1 2 3 4 5

G. Overall Care	Dissatisfied	Satisfied
1. Overall rating of Student Health Service	1 2 3 4 5
2. Would you recommend the service to others?	Yes No

Additional Comments:


*Your Status:**	Student Employee

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