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Dr. Randy Pastor Student Health Clinic Patient Satisfaction Survey

UCA Student Health Clinic Patient Satisfaction Survey

Date of Visit
Your Care From Nurses (LPN, RN, or MA who documented the reason for your visit)
During your visit, how often did the nurses treat you with courtesy and respect?
- Never
- Sometimes
- Usually
- Always
During your visit, how often did nurses listen carefully to you?
- Never
- Sometimes
- Usually
- Always
Did the nurses explain things in a way you could understand?
- Never
- Sometimes
- Usually
- Always
Comments
Your Care From Providers (Physician or Advanced Practice Registered Nurse)
During your visit, how often did the provider treat you with courtesy and respect?
- Never
- Sometimes
- Usually
- Always
During your visit, how often did the providers listen carefully to you?
- Never
- Sometimes
- Usually
- Always
Did the providers explain things in a way you could understand?
- Never
- Sometimes
- Usually
- Always
Comments
Your Care in Lab/X-ray
Did the laboratory/x-ray staff treat you with kindness and respect?
- Never
- Sometimes
- Usually
- Always
Did the laboratory/x-ray staff listen carefully to you?
- Never
- Sometimes
- Usually
- Always
Did the laboratory/x-ray staff explain things in a way you could understand?
- Never
- Sometimes
- Usually
- Always
Comments
The Clinic Environment
Were the waiting areas, exam rooms, lab, and/or x-ray clean and tidy?
- Never
- Sometimes
- Usually
- Always
How long were you kept waiting to see a nurse or provider?
- Greater than 10 minutes
- Around 10 minutes
- Less than 10 minutes
During your visit were you given any medication or prescription that you had not had before?
- Yes
- No
Before giving you any new medication or prescriptions, did the clinic staff tell you what the medications or prescriptions were for?
- Yes
- No
Before giving you any new medication or prescriptions, did the clinic staff describe possible side effects in a way you could understand?
- Yes
- No
Did you receive written information about what symptoms or health problems to look out for when you were discharged?
- Yes
- No
Would you recommend this clinic to other UCA students, faculty, or staff?
- Definitely No
- Probably No
- Probably Yes
- Definitely Yes
Using any number between 0-10 (where 0 is the worst clinic possible and 10 is the best clinic possible), what number would you use to rate your overall visit?
Comments
If you would like to be contacted to discuss your concerns, please provide us with the following information.
Name
First Last
Phone
Email
UCA ID

Student Health Building – 1st Floor
201 Donaghey Avenue
Conway, AR 72035
Phone: (501) 450-3136
Fax: (501) 450-3370
shc@uca.edu

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For MEDICAL EMERGENCIES please call Campus Police at (501) 450-3111 or dial 911.

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University of Central Arkansas · 201 Donaghey Ave., Conway, AR 72035 · (501) 450-5000
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