- Your feedback is important to us...
Our goal is to provide quality affordable health care to you. Let us know how we are doing! Please take a few moments to print out this page and fill out the form below. You can either drop it off at the front desk, or mail it to us at:
Partnership Health Center
Patient Satisfaction
323 West Alder Street
Missoula, MT 59802
All answers are confidential and will not in any way effect your ability to access services at Partnership Health Center.
You can also open up this form in Adobe Acrobat Reader. You can then circle and write your answers on the printed form.
Adobe Acrobat Portable
Document Format (.pdf) Version
- The time of day of my visit was:
- ______ 8am - 10am
- ______ 10am - 2pm
- ______ 2pm - 6pm
- ______ 6pm- 8pm
- Ease of getting care:
- Ability to get in to be seen:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Hours Center is open:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Phone system:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Reception:
- Time in reception area:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Comfort level of reception area:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Staff:
- Reception:
- Friendly and Helpful:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Takes enough time with you:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Explains what you want to know:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Nurses and Medical Assistants:
- Friendly and helpful to you:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Provider (Physician, Physician Assistant,
Nurse Practitioner):
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Pharmacy
- Friendly and helpful to you:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Answers your questions:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Payment:
- Copay:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Explanation of charges:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Facility:
- Neat and clean building:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Parking:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- Confidentiality:
- Keeping my personal information private:
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- The likelihood of referring your friends and relatives to us:
-
- ______Great
- ______Good
- ______Okay
- ______Fair
- ______Poor
- What do you like best about our center?
- ______________________________________________________
- ______________________________________________________
- ______________________________________________________
- ______________________________________________________
- What do you like least about our center?
- ______________________________________________________
- ______________________________________________________
- ______________________________________________________
- ______________________________________________________
- Has our recent change to Electronic Medical Recordkeeping improved your visit? Yes No
Thank you for completing our survey!
