Medical Clinics Evaluation

Gender:

Male

Female

Primary care physician seen today:

Daigle

Ewing

Hindelang

Honigman

Kemp

Ogden

Ordeneaux

Parra

Clinic visited:

Ear/nose/throat (Fourrier)

Dental (W.Atkinson)

Dermatology (Burglass/Sherman)

Eye (Murtagh)

Orthopedics (Winder/Rills/Bankston)

Women’s Clinic (Hindelang/Ogden)

Injection Clinic

Please rate the services provided to you:

Receptionists

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

Nurse

Courtesy
Poor 1 2 3 4 5 Excellent

Compassion
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

Physician

Courtesy
Poor 1 2 3 4 5 Excellent

Compassion and interest in you as a person
Poor 1 2 3 4 5 Excellent

Answering questions
Poor 1 2 3 4 5 Excellent

Thoroughness in discussing problem, treatment plans
Poor 1 2 3 4 5 Excellent

Where Applicable:

Injection Clinic

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

Lab

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor Poor 1 2 3 4 5 Excellent

Pharmacy

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

X-Ray

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

As a whole, how are you pleased with the Medical Clinics?

Very Displeased

Moderately Displeased

Moderately Pleased

Very Pleased

Primary reasons you use the Medical Clinics (Check all applicable):

Convenience

Confidence in medical staff

Emergency

Previous visits satisfactory

Prepaid service

Suggested by friends

Relatively Inexpensive

Other Please Specify:

After being assigned, how long did you wait to see a physician?

Comments or Complaints
Please describe the incident and the staff member involved.

Suggestions:

You may remain anonymous; however if you desire a personal response or if you have a specific complaint against a staff member, the following information is necessary.

First Name:

Last Name:

Address:

Telephone:

Email:

If you have any further questions or comments, please direct them to:

Arthur A. Goulas
Assistant Vice Chancellor for Finance and Administrative Services
and Director, LSU Student Health Center
Room 150, Phone: 225-578-6271

THANK YOU FOR YOUR RESPONSE.