Patient Satisfaction Survey

Patient Satisfaction Survey

1. The following statement is related to your feelings about the Care Coordination staff. The staff is helpful.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

2. The following statement refers to the health care you receive from the Care Coordination program. Information given to me about my health is clear and adequate.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

3. Your Care Coordinator has a thorough understanding of the things that are wrong with you.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

4. Please rate the following aspects of the health care you received from Care Coordinators in the past 12 months. Advice the Care Coordinator gives you about ways to avoid illness and stay healthy.

• Excellent (1)

• Very Good (2)

• Good (3)

• Fair(4)

• Poor(5)

• Not Applicable (6)

5. How much do you agree or disagree with the following statement about the Care Coordination care you have received in the past 12 months? I would recommend this type of care to my family or friends who have chronic diseases.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

6. Think about the care you receive from your Care Coordinator. You often have health problems that should be discussed but are not.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

7. The following statement refers to your Care Coordinator. It is easy to understand what the Care Coordinator is talking about.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)

8. The information given by the Care Coordinator about my medical problems helps me to adjust to my condition.

• Strongly agree (1)

• Agree (2)

• No opinion (3)

• Disagree (4)

• Strongly disagree (5)

• No Experience (6)