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For more information:

Potter Building
6 Butterfield Road
Kingston, RI 02881

401-874-2246

health@etal.uri.edu

Patient Care Survey

In our continued efforts to serve your needs and provide quality health services, we ask that your complete the following questionnaire. We would like to thank you in advance for your cooperation.


1. The reason I came to the clinic today:
 Illness
Allergy/Immunization/RN Clinic Only
Pharmacy Only
Medical Advice/Lab Results
Women's Clinic
Specialty Clinic
Health Ed/Nutritionist
Other

2. The following statements refer to the access and convenience of the Health Services Clinic.
(1) The clinic hours are convenient for me.
Strongly Agree
Agree
Disagree
Strongly Disagree

(2) The time spent waiting in the clinic was reasonable.
Strongly Agree
Agree
Disagree
Strongly Disagree

(3) The allergy/immunization appointments are convenient for me.
Strongly Agree
Agree
Disagree
Strongly Disagree

3. The following statements refer to the care you received on today's visit.
(1) The clinic provided me with the care I expected.
Strongly Agree
Agree
Disagree
Strongly Disagree

(2) I understand all the tests and/or examinations that were done today.
Strongly Agree
Agree
Disagree
Strongly Disagree

(3) I found the information about my health useful.
Strongly Agree
Agree
Disagree
Strongly Disagree

(4) The information given to me today about my health and or medication was clear and complete.
Strongly Agree
Agree
Disagree
Strongly Disagree

(5) I am satisfied with my visit.
Strongly Agree
Agree
Disagree
Strongly Disagree

(6) I received what I came for today.
Strongly Agree
Agree
Disagree
Strongly Disagree

(7) I was asked about pain and it was effectively managed.
Strongly Agree
Agree
Disagree
Strongly Disagree

4. The following statements relate to your feelings about the staff.
(1) The staff was friendly and helpful.
Strongly Agree
Agree
Disagree
Strongly Disagree

(2) The staff treated me with respect, consideration and dignity.
Strongly Agree
Agree
Disagree
Strongly Disagree

(3) I was provided with the appropriate privacy and confidentiality.
Strongly Agree
Agree
Disagree
Strongly Disagree

(4) The staff gave me opportunities to ask questions.
Strongly Agree
Agree
Disagree
Strongly Disagree

(5) The staff listened to me effectively.
Strongly Agree
Agree
Disagree
Strongly Disagree

5. Would you recommend the Health Services Clinic to other students?
 Yes
No

6. Tell us how our overall services or patient safety could be improved.

7. What questions do you have regarding Health Services?

8. What other services would you like provided at Health Services?

9. Please circle or fill in the best response for each item.
(1) I am a...
Freshman
Sophomore
Junior
Senior
Grad Student
Spouse of Student

(2) I live...
on campus
off campus

(3) Age


(4) Sex
Male
Female

(5) Ethnic/Cultural background:


(6) How did you make your appointment?
Walk in
Phone

(7) Time and day of your visit:


(8) Optional: Name:


(9) Optional: Phone#:


(10) How many minutes did you spend waiting?


10. If you used Self-Checkin, did you have a good experience?
 If yes, why? If not, why not?