Patient Survey

Customer Satisfaction Survey

Please rate the services you received while at the center. Choose the appropriate response or fill in the text box if appropriate.

Location:	Maude L. Whatley Health Center Theodore R. Hendrix Dental Center James O. Ellis Health Center Crescent East Health Center West Blocton Health Center Vernon Health Center Whatley Health Services @ Oakman Whatley Health Services @ Sipsey Sumter County Health Center Whatley Health Services at Eutaw Hale County Health Center Hale County Dental Center
What services did you use during your visit?	Select One: Medical (Pediatrician) Medical (Family Practice) Dental Other
If other, please describe here.:
How did we do in providing the information/services you needed?	Select One: Excellent Good Fair Poor
Were we courteous?	Select One: Yes No
Were we helpful?	Select One: Yes No
Were we knowledgeable?	Select One: Yes No
How long did you wait before receiving services?
Was the waiting time acceptable?	Select One: Yes No
Please rate: Getting an appointment:	Select One: Excellent Good Fair Poor
Please rate: Your understanding of the treatment/instructions you received:	Select One: Excellent Good Fair Poor
Please rate: Your understanding of billing policies and procedures:	Select One: Excellent Good Fair Poor
Are you satisfied with the hours of operation?	Select One: Yes No
If no, what additional hours would be helpful?
How likely is it that you will return to the Center?	Select One: Very Likely Somewhat Likely Not Sure Definitely Not
What suggestions do you have to improve the Center?
Why did you come to the Center?
Was the Center easy to find?	Select One: Yes No
What mode of transportation did you use to get to the Center?
Is transportation a problem for you?	Select One: Yes No
Is the location of the Center convenient for you?	Select One: Yes No
Were the facilities physically accessible?	Select One: Yes No
Were the services easy to use?	Select One: Yes No
How did you learn about the Center?	Select One: Newspaper TV/Radio Friend/Family Agency Referral School Other
If other, please describe:

© 2009 Whatley Health Services    All Rights Reserved

Web Development by Infomedia