Form VA Form 10-211003 VA Form 10-211003 MSCoE Patient Survey

Christopher Bever, MD, MBA
Director
Walter Royal, III, MD
Associate Director, Research
Mitchell Wallin, MD, MPH
Associate Director, Clinical
Care

Dear Honored Service Members and Veterans:

W. Joel Culpepper, PhD
Associate Director,
Epidemiology & Outcomes

At the VA Multiple Sclerosis Centers of Excellence, we want all of our Veteran patients to
have an excellent care experience in our MS clinics. Your opinions tell our healthcare
providers where we need to focus our attention, as well as where our efforts are
successful.

Joseph Finkelstein, MD, PhD
Associate Director,
Informatics

We would appreciate you taking few minutes to complete the survey in the manner most
convenient for you”

Terry Lee-Wilk, PhD
Neuropsychologist

On your computer: complete the survey on the internet at:
http://edu.surveygizmo.com/s3/1243887/MSCoE-Patient-Satisfaction-Survey

Heidi Maloni, PhD, ANP,
MSCN
National Clinical Nurse
Director
Lisa Mitchell, RN, BSN, MSCN
National MSCoE Nurse
Coordinator
Maggie Kazmierski, LCSW-C,
MSCS
SCI/D Coordinator & MSCoE
Social Worker
R. Andrew David, MS, MHSA
Acting Business Manager

By mail: complete the attached paper survey and mail it back in the enclosed return
envelope.
Your feedback is very important to us and will remain confidential. Feel free to express
your opinions honestly. Your comments and recommendations will make a difference in
our ability to improve patient care.
If you have difficulty completing this survey, or have any questions, please call (410) 6057480. Thank you very much for your participation.
Respectfully,

Angela Y. Young, MBA
Coordinator,
Education & Training

Mitchell T. Wallin, MD, MPH
Associate Director, Clinical Care
VA MS Centers of Excellence
MS Center of Excellence, East
10 N Greene Street
Baltimore, MD 21201
Phone: 410 – 605 – 7480
800 – 463 – 6295 x7480

MSCoE Patient Satisfaction Survey
Title
Veterans Health Administration
VA Multiple Sclerosis Centers of Excellence (MSCoE)
Outpatient Clinic Patient Satisfaction Survey

Survey
1. Please specify the location of your MS clinic visit. (organized alphabetically)
Albany, NY
Ann Arbor, MI
Atlanta, GA (Decatur)
Augusta, MA
Baltimore, MD
Bay Pines, FL
Birmingham, AL
Boston, MA
Buffalo, NY
Charleston, SC
Cleveland, OH
Detroit, MI
East Orange, NJ
Hampton, VA
Indianapolis, IN

Lake City, FL
Lebanon, PA
Manchester, NH
Martinsburg, WV
Memphis, TN
Miami, FL
New York, NY
Philadelphia, PA
Pittsburgh, PA
Providence, RI
Richmond, VA
Salisbury, NC
San Juan, PR
Syracuse, NY
Tampa, FL
Washington, DC
West Haven, CT
Wilmington, DE

2. I am satisfied with the medical care I receive in MS clinic. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

3. I feel my MS health care provider treated me with compassion and understanding. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

4. I feel my MS health care provider spent enough time listening to and addressing my concerns. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

5. I feel my MS health care provider gave me enough information on my condition and treatment. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

6. I was able to get an appointment with the MS clinic when I needed. *

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

7. I was seen promptly when I arrived at the MS clinic. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

8. The MS staff were helpful when I phoned for an appointment. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

9. The MS staff were helpful when I phoned for (a) medication refill(s). *
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
No Opinion

10. The MS staff were helpful when I phoned with questions. *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
No Opinion

11. Please describe what we could improve in the MS clinic. Your direct comments help us to improve
the medical services we provide to you. Please do not include any personally identifiable information
in your response.

Thank You!
Thank you for taking our MS Clinic Survey. Your response is very important and will help us improve
the services we provide.