Policy & Program


School-Based Health Centers - Implementation Tools

VIKING HEALTH CENTER STUDENT SATISFACTION SURVEY
RAVENSWOOD HOSPITAL MEDICAL CENTER



1. Female_______ Male_______


2. What grade are you in?

9th_____ 10th_____ 11th_____ 12th_____


3. How many times have you used the Health Center? (including today)

First time_____ 2-5 times_____ 6-10 times_____ more than 10 times_____

Answer the next questions about this visit to the Health Center

4. How does the Health Center look?

Excellent_____ Very good_____ Good_____ Could be improved_____


5. How did the Health Center staff treat you?

Excellent_____ Very good_____ Good_____ Could be improved_____


6. How would you rate the medical treatment you received?

Excellent_____ Very good_____ Good_____ Could be improved_____


7. How long did you have to wait before you saw a nurse or doctor?

__ Less than 5 mins __ 5-10 mins __ 11-15 mins __ more than 15 mins


8. This visit was: _____ an appointment _____ a walk-in.


9. Did you learn anything new today about taking care of yourself?
____ Yes ____ No


10. Did you feel your privacy was respected?
____ Yes ____ No


11. What else would you like to say about the Health Center?

______________________________________

______________________________________

______________________________________

______________________________________



For more information, please contact:
Brenda Bannor
Director, School-Based Health Ctrs
Ravenswood Hospital
773-878-4300 (phone)
773/279/4195(fax)
Email: bbannor@rmhc.com