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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.
1.
Please select any provider(s) that you have seen in the past 6 months.
Sarah Rury
Rachel Katz
Nancy Bohan Broderick
Rachel Bensen
Audrey Clark
Candiace Coleman
Maria Heidenreich
Rebecca Jackson
Stephen Segatore
Ellen Walsh
Hemant Bhaskar
Celeste Chickering
Samantha Dunn
Marwa Elleboudy
Carl Gimbrone
Stephanie Perkins
Richard Szal
Dolores Porter
Anna Snow
Min Cheng
Alex Kim
Other (please specify)
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?
Always
Usually
Sometimes
Never
In the last 6 months, do you feel that the issues you made an appointment for were addressed?
Always
Usually
Sometimes
Never
In the last 6 months, did you feel listened to and respected by the provider you were seeing?
Always
Usually
Sometimes
Never
3.
How would you rate your experience with this provider?
Lowest Rating
1 star
2 stars
3 stars
4 stars
5 stars
6 stars
7 stars
8 stars
9 stars
Highest Rating
10 stars
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?
Always
Usually
Sometimes
Never
When you contacted us during regular office hours, how often did you get an answer to your question that same day?
Always
Usually
Sometimes
Never
When scheduling an appointment for care you needed right away, how often were you able to see the clinician you wanted?
Always
Usually
Sometimes
Never
5.
Please Tell Us About Your Experience With Our Receptionists, and Call Agents.
Always
Usually
Sometimes
Never
While visiting our office, did you feel listened to and respected by our staff other than the provider(s)?
Always
Usually
Sometimes
Never
While on the phone, did you feel listened to and respected by our staff other than the providers(s)?
Always
Usually
Sometimes
Never
6.
Did you receive information about what to do if you needed care when the office was closed?
Yes
No
7.
Are you aware that financial assistance is available?
Yes
No
8.
Are you aware that the Health Center can offer you a Sliding Fee based on your income?
Yes
No
9.
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
10.
When you call into the Health Center, the phone tree options are easy to understand and get you to the right department quickly.
Strongly agree
Agree
Disagree
Strongly disagree
11.
If you selected the option to schedule, change, or confirm an appointment, how often did that request go smoothly for you?
Every time
Most of the time
Sometimes
Never
N/A
12.
If you are trying to reach a clinical staff member, you are able to do so easily and quickly.
Strongly agree
Agree
Disagree
Strongly disagree
13.
If you spoke with one of our scheduling staff, how would you describe the customer service level of that person?
Excellent
Good
Average
Fair
Poor
14.
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:
