Patient Satisfaction Form

WPI students who have utilized any of the programs or services offered by Student Health Services are encouraged to take the Patient Satisfaction Survey to provide comments, ratings, and more information about their experience.

Please answer the following questions about your experience with us:

Have you utilized Health Services within the last year?

Yes

No

On a scale of 1 to 5 (1 being very difficult and 5 being very easy), how was your experience making an appointment in Health Services?

In the box below, please comment on what health services could do to improve your experience at making appointments.

If our receptionist provided you with service, please indicate your level of satisfaction with the receptionist (1 being unsatisfied and 5 very satisfied).

Were you greeted in a welcoming and helpful manner by our staff? (1 being very negative and 5 very positive)

During your most recent visit, did you see your healthcare provider in a timely manner of your appointment time? Wait time includes time spent in the waiting room and exam room.

Yes

No

How long was the wait from the scheduled time of appointment?

< 5 minutes

5 - 15 minutes

> 15 minutes

During your most recent visit if a nurse practitioner assessed or treated you , please indicate your level of satisfaction with the care provided ( 1 being unsatisfied and 5 very satisfied).

During your most recent visit if a physician assessed or treated you , please indicate your level of satisfaction with the care provided (1 being unsatisfied and 5 very satisfied).

Indicate your level of satisfaction with the attention your caregiver showed to your current condition and your healthcare beliefs (1 being unsatisfied and 5 very satisfied).

Indicate your level of satisfaction with instructions and health education regarding diagnosis/medications/lab tests/x-ray/referrals you received during your most recent visit (1 being unsatisfied and 5 very satisfied).

Indicate your level of satisfaction with instructions you received about how to take care of yourself and if and when you should return to health services (1 being unsatisfied and 5 very satisfied).

Were you notified of your lab results or x-ray results via phone call or secure message?

Yes

No

Comments

Were you satisfied with the cleanliness of Health Services (1 being unsatisfied and 5 very unsatisfied)?

General Comments

If you wish to identify yourself for a follow-up interview, please leave your information below:

Name

Email

Phone Number

Date of Visit +

Who was your appointment with?

Currently, what country are you physically present in? *

*

By providing the information requested in this form, you are consenting to WPI’s use of the provided information for the purpose for which the form is being used. See Privacy Policy Below.