PADRON-TIBIO MEDICAL CLINIC PADRON-TIBIO MEDICAL CLINIC

Pasuquin St. San Jose, Aurora, Isabela Pasuquin St. San Jose, Aurora, Isabela

Department: ____________________________ Department: ____________________________

We would like to know how you feel about the services we recently provided to you. We would like to know how you feel about the services we recently provided to you.
Your assistance is very important to us so we can continue to provide exceptional service to Your assistance is very important to us so we can continue to provide exceptional service to
our patients and families. All responses will be kept confidential. our patients and families. All responses will be kept confidential.

Please (√) the box that best describe how well you think we provide each of the Please (√) the box that best describe how well you think we provide each of the
following service: following service:
5. EXCELLENT 4. VERY GOOD 3. GOOD 2. FAIR 1. POOR 5. EXCELLENT 4. VERY GOOD 3. GOOD 2. FAIR 1. POOR
1.PHYSICIAN 5 4 3 2 1 1.PHYSICIAN 5 4 3 2 1
a. How well physicians communicate with the patient e. How well physicians communicate with the patient
b. Satisfied with the immediate care provided f. Satisfied with the immediate care provided
c. Satisfied with the treatment carried out for your patient g. Satisfied with the treatment carried out for your patient
d. Explained what you needed to know about the illness of h. Explained what you needed to know about the illness of
your patient your patient

2. STAFF 5 4 3 2 1 2. STAFF 5 4 3 2 1
a. Satisfied with the behavior of nurses f. Satisfied with the behavior of nurses
b. Listened and answers questions and concerns you had g. Listened and answers questions and concerns you had
c. Treated you with courtesy and respect h. Treated you with courtesy and respect
d. How responsive to patients needs i. How responsive to patients needs
e. Giving instruction about follow-up care j. Giving instruction about follow-up care

3. FACILITY 5 4 3 2 1 3. FACILITY 5 4 3 2 1
a. Cleanliness of the hospital c. Cleanliness of the hospital
b. Ease to find where to go d. Ease to find where to go
4. How do you rate the time taken for management of patient 4. How do you rate the time taken for management of patient
5. How long was you wait 5. How long was you wait
6. Please rate your overall experience in the hospital 6. Please rate your overall experience in the hospital

7. What did you like best about your care? ______________________________________ 7. What did you like best about your care? ______________________________________
8. Comments and Suggestions for improvements. _______________________________ 8. Comments and Suggestions for improvements. _______________________________

NAME (OPTIONAL):____________________________________ DATE: ______________ NAME (OPTIONAL):____________________________________ DATE: ______________

Thank you for completing our survey! Thank you for completing our survey!