Skip to content

CLICK NOW TO BOOK APPOINTMENT / (844)444-1424

ABOUT
SERVICES
PATIENTS
COMMUNITY RESOURCES
CONTACT
LOCATIONS

(844)444-1424 / CLICK NOW TO BOOK APPOINTMENT

PATIENT EXPERIENCE SURVEY

PATIENT EXPERIENCE SURVEY

SURVEY SOURCE:

Website Postcard Link Tablet (Onsite) Lobby Station (Onsite) Exam Room (Onsite) Other

TODAY DATE

DATE OF LAST VISIT

IF YOU DON'T REMEMBER YOUR LAST VISIT PLEASE GIVE AN APPROXIMATE MONTH AND YEAR

LOCATION OF LAST VISIT

WHO WAS YOUR LAST DOCTOR

FIRST NAME

LAST NAME

TSCHC Hours of operation meet your needs

Very Good Good Fair Poor Very Poor

EASE OF MAKING AN APPOINTMENT ON PHONE

Very Good Good Fair Poor Very Poor

THE COURTESY OF THE PERSON WHO TOOK YOUR CALL

Very Good Good Fair Poor Very Poor

AVAILABLE APPOINTMENT TIMES

Very Good Good Fair Poor Very Poor

OUR ABILITY TO RETURN YOUR CALLS WITHIN 24 HOURS

Very Good Good Fair Poor Very Poor

TSCHC fees are affordable and will not keep you from returning to our clinic

Very Good Good Fair Poor Very Poor

Our ability to have you seen by the provider within 20 minutes of your appointment

Very Good Good Fair Poor Very Poor

Keeping your informed of delays while in the waiting room

Very Good Good Fair Poor Very Poor

Discharged 15 minutes after doctor's examination

Very Good Good Fair Poor Very Poor

The overall experience with the length of your visit

Very Good Good Fair Poor Very Poor

My provider is concerned about me as a person and not just my illness

Very Good Good Fair Poor Very Poor

Explained things in a way you could understand

Very Good Good Fair Poor Very Poor

Listened carefully to you

Very Good Good Fair Poor Very Poor

Respected what you had to say

Very Good Good Fair Poor Very Poor

Overall experience with provider

Very Good Good Fair Poor Very Poor

Your willingness to recommend this provider to friends or family

Very Good Good Fair Poor Very Poor

Front desk was helpful during visit

Very Good Good Fair Poor Very Poor

The courtesy of the front desk staff

Very Good Good Fair Poor Very Poor

If you applied for assistance (i.e. you qualified for a program to help pay for your care such as MHLA), was the staff helpful?

Very Good Good Fair Poor Very Poor

The efficiency of the check-in process

Very Good Good Fair Poor Very Poor

Courtesy / friendliness of the Nurse / Assistant

Very Good Good Fair Poor Very Poor

Nurse / Assistant ability to keep you informed of delays once in the waiting room

Very Good Good Fair Poor Very Poor

Answered all your questions and provided you with adequate instruction

Very Good Good Fair Poor Very Poor

Ease of getting a referral when needed

Very Good Good Fair Poor Very Poor

The staff who took care of you worked well together

Very Good Good Fair Poor Very Poor

Someone from the clinic provided you the necessary tools to maintain health at home

Very Good Good Fair Poor Very Poor

Care provider's efforts to include you in decisions about your treatment

Very Good Good Fair Poor Very Poor

Information the care provider gave you about your medication

Very Good Good Fair Poor Very Poor

Instructions the care provider gave you about follow-up care

Very Good Good Fair Poor Very Poor

When you arrived, did someone greet you and if so, were they helpful

Very Good Good Fair Poor Very Poor

Overall experience at TRISTATE

Very Good Good Fair Poor Very Poor

Your willingness to recommend TRISTATE to friends or family

Very Good Good Fair Poor Very Poor

How did you hear about us

Internet Mailers Outreach Worker Event Signs/Billboard Other

Additional comments or suggestions (please use this space below)

Would you like to be contacted regarding this comment? If no, we respect your wishes and will not contact you regarding this matter.

Yes No

ABOUT

” Working in the Community, For the Community “

4141 1/2 Verdugo Rd., Los Angeles, CA 90065
(844) 444-1424
info@tristateclinics.org

LOCATION

SHOWCASE PARTNER

ABOUT

” Working in the Community, For the Community “

4141 1/2 Verdugo Rd., Los Angeles, CA 90065
(844) 444-1424
info@tristateclinics.org

LOCATION

SHOWCASE PARTNER

Facebook Instagram Linkedin Youtube

QUICK LINK

HOME
ABOUT
LOCATIONS
SERVICES
JOBS

CONTACT US

Administrative Office: 4141 1/2 Verdugo Rd., Los Angeles, CA 90065
(844)444-1424
info@tristateclinics.org

Call Now To Book Appointment

Español »

ABOUT
SERVICES
PATIENTS
COMMUNITY RESOURCES
CONTACT
LOCATIONS