OMB Control Number: 2900-0770
Estimated Burden: 5 minutes
Expiration Date: 09/30/2020
VA Loma Linda Healthcare System CBOC Clinics
Patient Survey for Victorville
Date of Visit _________________
Who did you see as your Doctor/Provider today? ______________________________
How long did you wait to be seen by your provider after your scheduled time?
<15 minutes 15-30 minutes >30 minutes
How would you rate the courtesy and help of our Front Desk and Support staff?
1 2 3 4 5
How would you rate the care you received from our Nursing Staff today?
1 2 3 4 5
5. How would you rate the care you received from your Doctor/Provider?
1 2 3 4 5
6. How would you rate the ease to contact the clinic and/or provider by Phone or Secure Messaging ?
1. 2. 3. 4. 5
7. Anyone you would like to thank today?__________________________________
8. Is there anything we can do to improve?
Name (Optional) __________________________________________
Comments concerning the accuracy of the burden estimate and any suggestions for reducing this burden should be sent to Alicia Garcia, CBOC Director, email: Alicia.Garcia@va.gov .
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Geslani, Bevan A. |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |