Provider Survey - PALS for Health

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HEALTHCARE PROVIDER SURVEY

We know that you are very busy, but please take a few minutes to answer the following questions – to help improve our services to you and your limited English proficient (LEP) patients in the future. Your answers will remain confidential, and your participation is completely voluntary. Thank you for your valuable time and assistance!

* Indicates required field

Facility or Organization *

Date of the Appointment *

Your Name *

First

Last

Time of Appointment *

Email *

Phone Number *

Your Interpreter's Name *

First

Last

Quality of Today’s Interpretation Service

1. Was the interpreter on time? *

Yes No

2. Was the interpreter's attitude pleasant at your appointment? *

Yes No

3. Was the interpreter's behavior professional? *

Yes No

4. Was the interpreter dressed appropriately? *

Yes No

5. Did you feel the communication was effective? *

Yes No

6. Do you think there were any misunderstandings between you and the patient? *

Yes No

7. I would gladly work with this interpreter again? *

Yes No Neither (Neutral)

8. I would rate my overall satisfaction with the services as: *

Excellent Good Satisfactory Fair Unsatisfactory Poor

9. May we share this evaluation with the interpreter? *

Yes No

10. Please provide any additional comments: *

SUBMIT

Thank you!

PALS for Health is a division of Special Service for Groups
515 S. Columbia Ave. Suite 320
Los Angeles, CA 90017
P: (213) 553-1818 | F: (213) 553-1876 | E: info@palsforhealth.org

Home
About Us
Translation
Interpretation
Trainings
Language Assessment
- SCHEDULE LANGUAGE ASSESSMENT
- FAQ
Contact Us
Payment
- Donations
Provider Survey
Community Outreach & Education
Community Calendar
PALS Corner