The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Untitled form
Send
Untitled form
Section 1 of 2
Section 2 of 2
Question
Question Type
Loading image...
Broadway
Columbus Junction
St. Pat's
Street Med
West Liberty
Shelter House
Pheasant Ridge
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Email, call, text, or flier from the school
Facebook page
Flier hanging in the community
Friend/Word of mouth
Mobile Clinic's website
Internet search
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Blood Pressure check
Labs
to speak with a Doctor
Education
Flu Shot
HPV vaccine
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Primary care doctor/family physician
Free Medical Clinic in Iowa City
Emergency Room
Mobile Clinic at another site
Only this mobile clinic site
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
not at all
somewhat
completely
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Poor
Fair
Good
Excellent
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
First time
Once each month
A few times each year
Once every few years
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Dermatology
Ophthalmology
Psychiatry
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Message for respondents
This form is no longer accepting responses
Insights
Total points distribution
Loading...
Loading responses...
Location
No responses yet for this question.
How did you hear about the mobile clinic?
No responses yet for this question.
What services did you use?
No responses yet for this question.
Where else do you receive healthcare?
No responses yet for this question.
Were the mobile clinic volunteers able to answer your question/meet your needs today?
No responses yet for this question.
How is the mobile clinic doing? Please rate your satisfaction.
No responses yet for this question.
How often do you come to the mobile clinic?
No responses yet for this question.
How can the mobile clinic improve our services to you?
No responses yet for this question.
What other services would you like the mobile clinic to provide?
No responses yet for this question.
of
10
Main menu
.