University of Southern Indiana Student Health Center Patient Satisfaction Survey

University of Southern Indiana
Student Health Center
Patient Satisfaction Survey

Please help us to improve our services by completing the following survey. Your participation is voluntary and your responses will remain confidential.

1. I have used the Student Health Center. Yes No
If you answered no, please explain why you have never used the center in the comment section at the bottom of the survey.

Please rate your satisfaction with the following:

11. In your recent visit(s) to the Student Health Center who did you see?

12. Who would you be more likely to request an appointment with?

Please complete this section regarding your satisfaction with the care you received from the provider(s) (nurse practitioner and/or physician)

19. Are you enrolled in the Office Visit Plan? Yes No

20. How did you learn about the Student Health Center? (Please Check All That Apply)

Information mailed to home	From another student	Ad or article in "The Shield"
Information received at orientation	From an instructor	Referral from another office
Other:

Demographic Information

21. Gender: Male Female

22. Age:

23. Classification:

24. Ethnicity:

Please provide additional comments, especially regarding services with which you were very satisfied or very dissatisfied.

Thank you for your assistance.
Your time and thoughts are appreciated.

8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600

EMBOSSED USI LOGO

	Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied
2. Location of the Student Health Center
3. Convenience of the Student Health Center hours
4. Ease of scheduling appointments
5. Amount of time spent in waiting room
6. Cost and convenience of sample and/or prescription medicine
7. Courtesy and helpfulness of receptionist
8. Courtesy and helpfulness of nurse
9. Providers ability to provide clear instructions regarding your illness and treatment
10. Overall Satisfaction

	Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied
13. Courtesy of provider
14. Providers' patience and interest in your problem
15. Time provider spent with you
16. Providers' explanation of illness and treatment
17. Providers' explanation of medication prescribed
18. Other