NEMSA STAFF HEALTH CARE PROVIDER/HMO FEEDBACK QUESTIONNAIRE NEMSA STAFF HEALTH CARE PROVIDER/HMO FEEDBACK QUESTIONNAIRE Please take a few minutes to complete this confidential survey to help us understand your experience and improve our healthcare partnerships. Your responses will be taken care of with strict confidentiality. Section A: General Information Department/Unit Gender * Male Female Age Group * Under 25 25-34 35-44 45-54 55 and above Section B: Accessibility and Enrollment Were you properly enrolled with your HMO without issues? * Yes No If no, please explain: How easy was locating or choosing a primary healthcare provider/hospital under your HMO plan? * Very Easy Easy Neutral Difficult Very Difficult Have you ever had to change your primary healthcare provider/hospital? * Yes No If yes, why? Section C: Your Hospital/Clinic Experience How would you rate the following services at your hospital/clinic? * Very Good Good Fair Poor Very Poor Waiting time before seeing the doctor * Very Good Good Fair Poor Very Poor The doctor’s professionalism and attention * Very Good Good Fair Poor Very Poor Friendliness of nurses and staff * Very Good Good Fair Poor Very Poor Cleanliness of the facility * Very Good Good Fair Poor Very Poor Access to prescribed medication * Very Good Good Fair Poor Very Poor Laboratory/diagnostic services * Very Good Good Fair Poor Very Poor Overall hospital experience * Very Good Good Fair Poor Very Poor Have you ever had to pay out of pocket for any service that should have been covered? * Yes No If Yes, please specify: Section D: Regenix HMO Support Have you ever contacted Regenix directly for support or clarification? * Yes No If yes, how would you rate their customer service? Very Good Good Fair Poor Very Poor Ease of reaching Regenix Very Good Good Fair Poor Very Poor Helpfulness of staff Very Good Good Fair Poor Very Poor Response time Very Good Good Fair Poor Very Poor Resolution of issues Very Good Good Fair Poor Very Poor Communication clarity Very Good Good Fair Poor Very Poor Section E: Overall Satisfaction and Suggestions Overall, how satisfied are you with Regenix services? * Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied What has been your biggest challenge with Regenix or your hospital? What improvements would you like to see? Any additional comments or suggestions: Submit If you are human, leave this field blank.
