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Partnership Health Center
(406) 258-4789
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Missoula County - Partnership Health Center

Department: Partnership Health Center
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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.

An image of a portable document format PDF to indicate a link to a document. 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!

 

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