Patient Experience Survey 2016- Blue Valley Specialty and UC

THIS SURVEY IS CONFIDENTIAL

Patient Experience Survey
Please provide us with feedback regarding your experience with our Patient Access staff. Access Representatives are located at the front desks within the waiting areas and are who assist you with registering for your visit.

How was your overall registration process?
  *
Very Displeased
1
2
3
4
5
6
7
8
9 		Very Pleased
10
Registration Process
Please rate the friendliness of the Patient Access Staff.
  *
Very Unfriendly
1
2
3
4
5
6
7
8
9 		Very Friendly
10
Patient Access Staff
Please rate the professionalism of the Patient Access Staff.
  *
Very Unprofessional
1
2
3
4
5
6
7
8
9 		Very Professional
10
Patient Access Staff
Please rate the attentiveness of the Patient Access Staff.
  *
Very Inattentive
1
2
3
4
5
6
7
8
9 		Very Attentive
10
Patient Access Staff

Was there anything done particularly well during your registration experience that you would like to share?
Feedback Optional:

Is there anything that you feel that we could improve during the registration process?
Feedback Optional:

Would you like for us to contact you about today's visit?

No  
Yes (Please enter the phone number you would like to be contacted at)