Please take a few minutes to tell us how we have served you today. Your responses are strictly confidential. The information you provide helps us improve the quality of health care you receive at GHC.

Please give us a grade for the care you have received from GHC today. The grading system is as follows:

• A=excellent
• B=very good
• C=good
• D=fair
• F=poor
• NA= not applicable

Academic semester during which you received service Spring 2008 Winter 2008 Fall 2007 Summer 2007 Spring 2007 Winter 2007 Fall 2006 Summer 2006

1. The staff members with whom I dealt were knowledgeable.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable

2. I was treated respectfully and courteously? Please give each of us a grade.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable
Receptionist
Nurse Educator
Medical Assistant
Nurse Practitioner/Physician

3. I was able to meet with someone within a reasonable period of time.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable
If grade of D or F please answer the following: How long did you have to wait until you were taken back for your initial interview? minutes. How long did you have to wait until the nurse practitioner saw you? minutes. Were you given an explanation for the delay? Yes No

4. My personal and/or cultural preferences regarding my health care were taken into consideration.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable
If you gave a grade of D or F would you give an example of a personal or cultural preference that would have improved the health care you received.

5. My primary health concern(s) were addressed.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable

6. I was given enough information about my health problem(s) and treatment(s) to be able to confidently care for myself at home.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable
If you gave a grade of D or F, would you give an example of information related to your health problem that would have been helpful for you?

7. My questions were answered regarding billing, payment plan and insurance coverage for the services I received.	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable

8. I was able to easily access the clinic. Please grade each of the following areas:	A Excellent	B Very Good	C Good	D Fair	F Poor	NA Not Applicable
Ease of scheduling appointment
Convenient clinic hours
Convenient location
Physically accessible

9. I would recommend this service to fellow students.

Yes No If no, please explain reasons for not recommending

Any suggestions or comments that could improve the overall services at GHC would be appreciated

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