We're interested in making Yale Health work better for you. The more specific your comments the more helpful they will be in our efforts to maintain and improve the quality of staff and services.

1. What department(s) would you like to comment on?

2. Comments?

3. What is your impression of the Yale Health Staff involved today?

• - Physician
• - Nurse Practitioners
• - Nurse Midwives
• - Physician Associates
• - Nursing
• - Reception
• - Laboratory
• - X-ray
• - Physical Therapy
• - Administrative
• - Pharmacy

4. Do staff members seem to be interested in you as an individual?
Yes No

5. Has the health care you have received met your expectations?
Yes No

6. Has your medical condition(s) and/or the treatment(s) been adequately explained to you? Yes No

7. Has there been adequate follow-up to your medical problems and /or treatments? Yes No

8. Was there something about your experience with Yale Health that you found particularly satisfactory?
(If yes, please describe below or in comments section.)
Yes No

9. Was there something about your experience with Yale Health that you found unsatisfactory?
(If yes, please describe below or in comment section.)
Yes No

We are happy to help you. Should you wish to discuss any issue in more detail, please call the Member Services Department at 432-0246.

Do you wish a response? Yes No

May we use your name in discussing comment with relevant Yale Health staff members?
(if yes, please provide the following information.) Yes No

- Name (optional)

- Email(optional)

- Date

- Day Phone

- Evening Phone

- Yale Health ID#