Department of Psychiatry
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Patient Satisfaction Survey
  1. Please take a moment to answer a few questions about you, your visit, and your health care provider. The collected survey information is used to help us improve our service to you and to our community. We sincerely appreciate your time and effort.
  2. 1. Is someone other than the patient completing the survey?
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  3. 2. Is this the patient’s first visit?
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  4. 3. Gender:
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  5. 4. What clinic did you visit?
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  6. Other Clinic:
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  7. 5. What type of Insurance coverage do you have?
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  8. 6. Are parking services convenient?
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  9. 7. Please rate the courtesy of the reception staff.
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  10. 8. Please rate the cleanliness of the clinic.
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  11. 9. How long ago did you schedule today’s visit?
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  12. 10. Were you satisfied with the timeliness of your appointment?
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  13. 11. When I made the appointment, I was given the following information. (check all that apply)
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  14. 13. The length of time to check in at the Clinic was reasonable?
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  15. 14. How long did you wait in the reception area before being seen by your care provider?
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  16. 15. Was your wait time in the reception area reasonable to you?
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    15. Was your wait time in the reception area reasonable to you?
  17. 16. Please rate the courtesy of the nursing staff.
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  18. 17. Who did you see on your visit?
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  19. Who was your care provider on this visit?
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  20. 18. Did your provider spend enough time with you?
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  21. 19. Did your provider involve you in your treatment planning?
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  22. 20. Did your provider speak to you using words that you could understand?
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  23. 21. Did your provider treat you with respect?
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  24. 22. New medicines were explained to me, alternatives and side effects?
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  25. 23. My provider explained any ordered tests to me.
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  26. 24. My provider explained my treatment to me.
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  27. 25. Please rate the courtesy of your health care provider.
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  28. 26. Since beginning treatment at UAB my mental health has improved?
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  29. 27. Please comment on anything else you would like to bring to our attention.
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    (255 character limit)
  30. Thank You For Taking The Time To Complete Our Survey. Please Click On The Submit Button Below To Enter Your Survey