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.

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* 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)

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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

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* 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)?	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

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

Yes

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

Yes

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

Yes

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* 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

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* 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

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* 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

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* 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

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* 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

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* 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: