Rehabilitation and Audiology Customer Service Survey

Rehabilitation and Audiology Customer Service Survey

OMB No. 2900-0770
Estimated Burden: 15

Expiration Date: 08/31/2017

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 15 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve optimal rehabilitation and/or audiology services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

Patient Care Survey

1. Were you satisfied with the wait time to initially be seen in Physical Therapy/Occupational Therapy/Speech/Audiology?

2. Were you satisfied with the procedure for scheduling follow up appointments?

3. Were you satisfied with the overall care you received?

4. If we were unable to help you, were you referred back to your physician or to another specialty?

5. Did you feel that your provider(s) showed concern and care regarding your situation?

6. Do you have any suggestions to further improve care in PT/OT/Speech/Audiology?

7. Did your clinician explain your condition/situation in a manner that was plain and easy to understand?

8. Did your clinician explain the procedure(s) that were being done on your behalf in plain, easy to understand terms

9. Now think about your experiences with all the services provided by the Department of Veterans Affairs (which include healthcare, benefits programs, or memorial services). Please tell us how you feel about the following statements:

“I got the service I needed.”

Strongly disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly agree

“It was easy to get the service I needed.”

Strongly disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly agree

“I felt like a valued customer.”

Strongly disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly agree

“I trust VA to fulfill our country’s commitment to veterans.”

Strongly disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly agree

Thank you for your time and participation.

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