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SURVEY QUESTIONNAIRE

ASSESSMENT OF CLIENTS’ SATISFACTION WITH HEALTH CARE DELIVERIES IN SELECTED


PRIMARY HEALTH CARE CLINICS IN TAGUIG CITY

To the Respondents:

The undersigned are currently conducting a research study entitled Assessment of Clients’
Satisfaction with Health Care Deliveries in Selected Primary Health Care Clinics in Taguig
City. This is part of the requirements in Business Research and Scientific Writing course under the Master in
Business Administration (MBA) program of Taguig City University.

Please accomplish this survey questionnaire by answering all questions as honest as possible.
Information gathered will be treated with utmost confidentiality and for academic purposes only. Thank you
very much.

Sincerely yours,

Mary Joyce Cruz Dennis Masecampo Marivic Villarante Marlon Raquel

Part I: SOCIO-DEMOGRAPHIC PROFILE


___ Student ___ Self-employed
Age ___ years old Occupation ___ Rank-and-file ___ Others, please specify,
___Supervisory/Managerial ____________
___ P10,000 and below ___ P25,001-P30,000
___ Male ___ P10,000-P15,000 ___ P30,001-P35,000
Gender Monthly ___ P15,001-P20,000 ___ P35,001-P40,000
___ Female Income ___ P20,000-P25,000 ___ Above P40,000
___ Elementary
Education ___ High School Type of ___ New Visit
___ College Visit ___ Repeat Visit
___ Master’s/Doctorate
___ Single ___ Free (PhilHealth)
Civil ___ Married Payment ___ Cash
Status ___ Widowed Status ___ HMO (Medicare, etc)
___ Separated ___ Credit Card

PART II. ASSESSMENT OF SERVICE QUALITY DIMENSIONS OF PRIMARY HEALTH CARE CLINICS

Direction: On a scale of 1 to 5, indicate your assessment on the quality of services offered by the primary health
care clinic you recently visited.

5 4 3 2 1
INDICATORS Excellent Moderate Average Poor Very
Poor
RELIABILITY
1. When health care is promised, it is done. 5 4 3 2 1
2. Discipline of staff 5 4 3 2 1
3. Delivery of service right in the first time 5 4 3 2 1
4. Provision of health services at the time 5 4 3 2 1
promised
5. Keeping clients record correctly without 5 4 3 2 1
mistake
RESPONSIVENESS
1. Information provided on when services will 5 4 3 2 1
be performed
2. Provision of prompt service 5 4 3 2 1
3. Employees’ willingness to help 5 4 3 2 1
4. Accessibility of staff when needed
EMPATHY
1. Giving individual attention to each client 5 4 3 2 1
2. Operating hours appropriate for all clients 5 4 3 2 1
3. Employees give personal attention to client 5 4 3 2 1
4. Employees have best interest of clients at 5 4 3 2 1
heart.
5. Understanding of the specific needs of clients 5 4 3 2 1
ASSURANCE
1. Feeling security and safety in receiving 5 4 3 2 1
health care and communication with staff
2. Adequate explanation of health-related 5 4 3 2 1
problems
3. Employee knowledge to answer client 5 4 3 2 1
questions
4. Courteous and polite behavior towards 5 4 3 2 1
clients
TANGIBILITY
1. Neat and professional appearance of health 5 4 3 2 1
care staff
2. Cleanliness of health care environment 5 4 3 2 1
3. Adequacy of equipment in the health care 5 4 3 2 1
facility
4. Visual appealing and comfort of physical 5 4 3 2 1
facilities

PART III. MEASUREMENT OF OVERALL CLIENT SATISFACTION


1. From the scale of 1 to 5, what is 5 4 3 2 1
your level of satisfaction with the Very Satisfied Neutral Dissatisfied Very
services of primary health care Satisfied Dissatisfied
clinic?
2. From the scale of 1 to 5, how likely 5 4 3 2 1
are you to recommend this Extremely Very Moderately Slightly Not At All
primary health care clinic to Likely Likely Likely Likely
others?
3. From the scale of 1 to 5, how likely 5 4 3 2 1
are you to come back to this Extremely Very Moderately Slightly Not At All
primary health care clinic for Likely Likely Likely Likely
consultations and other services?

Thank you for your participation!

Respondent’s Signature: _________________________