Patient Experience of Care Brochure

12.7.2016_Brochure_IHSPatient Experience of Care Survey.docx

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

Patient Experience of Care Brochure

OMB: 0917-0036

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Welcome to Our Clinic!


Patient Experience of Care Survey


We’d like to introduce you to our new short Patient Experience of Care survey. We are asking you for information to help our quality improvement team understand how we can improve our service to you and others who come to our clinic. 


Patient Experience of Care Survey:

Participating in the survey is voluntary. It only takes a few minutes to complete the survey. Your name and personal information are protected and won't be connected to your answers.


If you decide to participate:

Before you leave the clinic today, a staff member will ask if you wish to participate. If you agree, a staff member will provide a tablet device. Using the touch screen, select the answer for each question that best describes your experience with the care you received today.  You can also provide more information and specific suggestions in the comments section.


If you need assistance:

If you have questions or need assistance, just ask -- our staff is ready to help.


Thank you!

We welcome and value your comments and suggestions of how we can provide better care.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWindows User
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File Created2022-02-21

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