CHCFC Patient Satisfaction Survey

We REALLY want to make our services more valuable to you. To do that, we depend on your FEEDBACK.

THANK YOU for taking a few minutes to complete this brief survey.

Question Title

* 1. Please select any provider(s) that you have seen in the past 6 months.

Sarah Rury

Rachel Katz

Nancy Bohan Broderick

Audrey Clark

Maria Heidenreich

Rebecca Jackson

Stephen Segatore

Lisa Miller

Connie Turner

Derek Luthi

Shannon Baker

Emily Parker

Hemant Bhaskar

Almabrouk Kernaf

Celeste Chickering

Samantha Dunn

Marwa Elleboudy

Stephanie Perkins

Richard Szal

Dolores Porter

Yaman Kana

Simon Rajan

Justin Ward

Min Cheng

Alex Kim

Kasey Erickson

Kelly Henry

Other (please specify)

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* 2. Please Tell Us About Your Care From This Provider in the Last 6 Months.

	Always	Usually	Sometimes	Never
In the last 6 months, how often did your provider explain things to you in a way that was easy to understand?	In the last 6 months, how often did your provider explain things to you in a way that was easy to understand? Always	In the last 6 months, how often did your provider explain things to you in a way that was easy to understand? Usually	In the last 6 months, how often did your provider explain things to you in a way that was easy to understand? Sometimes	In the last 6 months, how often did your provider explain things to you in a way that was easy to understand? Never
In the last 6 months, do you feel that the issues you made an appointment for were addressed?	In the last 6 months, do you feel that the issues you made an appointment for were addressed? Always	In the last 6 months, do you feel that the issues you made an appointment for were addressed? Usually	In the last 6 months, do you feel that the issues you made an appointment for were addressed? Sometimes	In the last 6 months, do you feel that the issues you made an appointment for were addressed? Never
In the last 6 months, did you feel listened to and respected by the provider you were seeing?	In the last 6 months, did you feel listened to and respected by the provider you were seeing? Always	In the last 6 months, did you feel listened to and respected by the provider you were seeing? Usually	In the last 6 months, did you feel listened to and respected by the provider you were seeing? Sometimes	In the last 6 months, did you feel listened to and respected by the provider you were seeing? Never

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* 3. How would you rate your experience with this provider?

Lowest Rating

Highest Rating

Lowest Rating

Highest Rating

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* 4. Please Tell Us About Your Experience With Accessing Appointments in Our Health Center

	Always	Usually	Sometimes	Never
When you contacted the Health Center to get an appointment for a check-up or routine care, how often did you get an appointment as soon as you need it?	When you contacted the Health Center to get an appointment for a check-up or routine care, how often did you get an appointment as soon as you need it? Always	When you contacted the Health Center to get an appointment for a check-up or routine care, how often did you get an appointment as soon as you need it? Usually	When you contacted the Health Center to get an appointment for a check-up or routine care, how often did you get an appointment as soon as you need it? Sometimes	When you contacted the Health Center to get an appointment for a check-up or routine care, how often did you get an appointment as soon as you need it? Never
When you contacted us during regular office hours, how often did you get an answer to your question that same day?	When you contacted us during regular office hours, how often did you get an answer to your question that same day? Always	When you contacted us during regular office hours, how often did you get an answer to your question that same day? Usually	When you contacted us during regular office hours, how often did you get an answer to your question that same day? Sometimes	When you contacted us during regular office hours, how often did you get an answer to your question that same day? Never
When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted?	When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted? Always	When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted? Usually	When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted? Sometimes	When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted? Never

Question Title

* 5. Please Tell Us About Your Experience With Our Receptionists, and Patient Service Representatives.

	Always	Usually	Sometimes	Never
While visiting our office, did you feel listened to and respected by our staff other than the provider(s)?	While visiting our office, did you feel listened to and respected by our staff other than the provider(s)? Always	While visiting our office, did you feel listened to and respected by our staff other than the provider(s)? Usually	While visiting our office, did you feel listened to and respected by our staff other than the provider(s)? Sometimes	While visiting our office, did you feel listened to and respected by our staff other than the provider(s)? Never
While on the phone, did you feel listened to and respected by our staff other than the providers(s)?	While on the phone, did you feel listened to and respected by our staff other than the providers(s)? Always	While on the phone, did you feel listened to and respected by our staff other than the providers(s)? Usually	While on the phone, did you feel listened to and respected by our staff other than the providers(s)? Sometimes	While on the phone, did you feel listened to and respected by our staff other than the providers(s)? Never

Question Title

* 6. When you call into the Health Center, the call is answered and my needs are addressed.

Strongly agree

Agree

Disagree

Strongly disagree

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* 7. If you called to schedule, change, or confirm an appointment, how often were you satisfied with the results?

Every time

Most of the time

Sometimes

Never

N/A

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* 8. If you spoke with one of our Patient Services Representatives, how would you describe the customer service level of that person?

Excellent

Good

Average

Fair

Poor

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* 9. Did you receive information about what to do if you needed care when the office was closed?

Yes

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* 10. Are you aware that financial assistance is available?

Yes

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* 11. Are you aware that the Health Center can offer you a Sliding Fee based on your income?

Yes

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* 12. If you used the Sliding Fee Discount Program, did the discount you receive make the care affordable?

Very affordable

Somewhat affordable

I did not qualify based on income and family size

Somewhat unaffordable

Very unaffordable

I chose not to apply

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* 13. When you request a refill, I get my medications refilled in a timely manner.

Strongly agree

Agree

Disagree

Strongly disagree

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* 14. I find my MyChart patient portal to be a useful tool in my healthcare management.

Strongly agree

Agree

Disagree

Strongly disagree

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* 15. I get timely responses from my clinical team when communicating through the MyChart patient portal.

Strongly agree

Agree

Disagree

Strongly disagree

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* 16. How likely would you be to recommend the Community Health Center to your family and friends?

Lowest Rating

Highest Rating

Lowest Rating

Highest Rating

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* 17. If you would like for us to contact you to follow up, please tells us how we may contact you.

Name:

Address:

City/Town:

Zip/Postal Code:

Country:

Email Address:

Phone Number: