Clinch Memorial Hospital Community Perception Survey 
We are always interested in what you have to say! It’s important that we check in with those we serve and ask for their feedback — this is one of those times.

The staff, providers and Hospital Authority at Clinch Memorial Hospital invite you to take a five-minute survey to let us know how we are doing, and more importantly, how we can better serve you in the future.

Please contact our Public Relations Director at (912) 470-2401 with any questions or to request a physical form. 

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1. What is your gender?
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2. What is your age? 
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3. Are you, your spouse, or any member of your immediate family, currently or formerly employed by Clinch Memorial Hospital? 
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4. Do you have children living in your household? If yes, please check all ages that apply.
5. Please select your insurance provider:
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6. If a local healthcare provider wanted to communicate information about their services to you, what would be your most preferred method(s) of receiving that information? Check all that apply
7. Have you received services from Clinch Memorial Hospital before?
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8. Overall how satisfied are you with Clinch Memorial Hospital? 
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9. How satisfied are you with the skill and competency of our medical staff throughout the Clinch Memorial Hospital (doctors, nurses, therapists, technicians)?
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10. How satisfied are you with the skill and competency of our support staff throughout the Clinch Memorial Hospital (security, receptionist, admissions representative, food service workers, housekeeping)?
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11. Why do you choose Clinch Memorial Hospital? 
12. In your opinion, what words describe Clinch Memorial Hospital and its family of clinics and facilities? Please list 3 to 5 words or short phrases below.
13. Clinch Memorial Hospital offers the following services. Which of these services are you aware of? 
14. Clinch Memorial Family Practice offers the following services. Which of these services are you aware of? 
15. What is your perception of Clinch Memorial Hospital's reputation in the community? Please answer even if you have not received services from us.
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16. If you choose to seek care out of town, why do you do so? (Please check all that apply.)
17. If you have chosen to seek care out-of-town, for which services have you gone elsewhere? Check all that apply. If other, please specify. 
18. When shopping for a healthcare provider, what quality do you value most? Please select just one answer.
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19. Based on your perception of Clinch Memorial Hospital, would you, or do you, recommend the hospital and its clinics to your friends, family and co-workers? If no, please tell us why in the "other" section below. 
20. If you are interested in Community Education Nights on various health topics, what is the best way to reach you to notify you of these educational sessions?
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20. At Clinch Memorial Hospital, our goal is to continually improve our services and patient care. Your opinion matters to us. Do you have any comments, praise or suggestions to share with the CMH staff? If so, please write in below.
What is your zip code? 
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