Patient Satisfaction Survey 2020
Please take a few minutes to fill out our survey!
How was your check in process today?
Very Good
Good
Fair
Poor
Very Poor
Clear selection
If you had to fill out paperwork did you find it reasonable?
Yes
No
N/A
Clear selection
How long did you have to wait to see the provider after your scheduled appointment time?
0-5 minutes
6-10 minutes
11-20 minutes
20+ minutes
Clear selection
How long did you have to wait to schedule an appointment?
I got an appointment the same day I called
1-3 days
4-7 days
Longer than a week
Other:
Clear selection
How many times a year do you have to visit another health care facility because we are not open?
Never
1-3 times
4-6 times
7-10 times
Other:
Clear selection
If you were able to choose a time frame outside normal business hours (8:00 am to 5:00 pm), which times would be more convenient for you and/or your family. (Check all that apply)
7:00 am - 8:00 am
5:00 pm - 8:00 pm
Saturday Morning
If you need a same-day appointment what time frame is best for you?
Late Morning
Early Afternoon
Close to the end of the day
Clear selection
Would you use a taxi service dedicated to health care?
Yes
No
Clear selection
How do you usually get to the Health Center? (Check all that apply)
Private Vehicle (car, truck, motorcycle, etc.)
Someone else drives you in a private vehicle (car, truck, motorcycle, etc.)
Public transit (bus, general public transportation)
Transit services (medical taxi service)
Walk/bike
Other:
Have you used Telehealth through the Health Center?
Yes
No
Clear selection
If you have used our Telehealth option, what was your experience?
Your answer
Do you feel that the Sliding Discount Fee is easy to understand if using the slide?
Very easy to understand
1
2
3
4
5
Very difficult to understand
Clear selection
Do you think the cost of the discount is reasonable? If using the slide.
Your answer
How can we make it easier to understand? If using the slide.
Your answer
If your test results were not reported at your appointment, did you feel they were reported in a reasonable amount of time?
Yes
No
Does not apply
Clear selection
Do you feel that your billing statement is easy to understand?
Yes
No
Does not apply
Clear selection
If you left a phone or portal message with a nurse were you satisfied with the length of time it took for a response?
Yes
No
Does not apply
Clear selection
Very Poor (1)
Poor (2)
Fair (3)
Good (4)
Very Good (5)
N/A
Friendliness/Courtesy of staff
Friendliness/Courtesy of care provider
The care provider showed efforts to include you in decisions about your treatment
How was the amount of time care provider spent with you
Cleanliness of Health Center facilities
Respect from the Behavioral Health provider regarding race, sex, religion, sexual orientation or ethnic heritage
If you needed help in the future what is your likelihood of returning to see a Behavioral Health provider here?
Overall, how satisfied are you with your visit here?
I rate the access to health care at the Health Center as...
What is the likelihood of you recommending the Health Center to others?
Very Poor (1)
Poor (2)
Fair (3)
Good (4)
Very Good (5)
N/A
Friendliness/Courtesy of staff
Friendliness/Courtesy of care provider
The care provider showed efforts to include you in decisions about your treatment
How was the amount of time care provider spent with you
Cleanliness of Health Center facilities
Respect from the Behavioral Health provider regarding race, sex, religion, sexual orientation or ethnic heritage
If you needed help in the future what is your likelihood of returning to see a Behavioral Health provider here?
Overall, how satisfied are you with your visit here?
I rate the access to health care at the Health Center as...
What is the likelihood of you recommending the Health Center to others?
Clear selection
To which gender identity do you most identify?
Your answer
What is your highest level of education?
Less than a high school degree
High school diploma
Tech/vocational school degree
Associates degree
Some college, no degree
Bachelors degree
Some graduate work, no degree
Graduate degree or higher
Clear selection
Please feel free to leave any comments below:
Your answer
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