JeffCare Satisfaction Survey

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* 1. Optional, contact information

First and Last Name

Email Address

Phone Number

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* 2. Which JeffCare Health Center are you providing feedback for?

JeffCare East Bank Health Center

JeffCare West Bank health Center

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* 3. Which service(s) did you receive today

Behavioral Health Medication Management

Behavioral Health Individual and/or Group Therapy

Behavioral Health Injection

Primary Care Services

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* 4. Ease of intake and registration as a new patient, skip if not applicable

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* 5. Helpfulness of the staff checking me in for my appointment, skip if not applicable

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* 6. Waiting time to check-in, skip if not applicable

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* 7. Comfort of the waiting area/lobby, skip if not applicable

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* 8. Feedback/comments on Administrative Support staff

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* 9. Helpfulness of nursing staff, skip if not applicable

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* 10. Trust in the skills of the nursing staff assisting you before seeing the provider, skip if not applicable

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* 11. Feedback/comment on nursing staff

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* 12. Satisfaction with your provider’s explanation of treatment/plan, skip if not applicable

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* 13. Treatment provider(s) provided me with an opportunity to ask questions, skip if not applicable

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* 14. Satisfaction with your provider(s) concern for your treatment, skip if not applicable

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* 15. Your trust in the skill of the provider(s) who provided your treatment, skip if not applicable

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* 16. Feedback/comment on treatment provider staff

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* 17. Staff members you interacted with treated you with respect and dignity

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* 18. Overall satisfaction with Covid precautions (staff wearing masks, distancing, signs posted with expectations, etc.)

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* 19. Responsiveness to any concerns/complaints reported during your visit, skip if not applicable

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* 20. Overall satisfaction with how well the staff worked together to provide your care

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* 21. Likeliness of you recommending JeffCare services to others

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* 22. Overall satisfaction with the average length of time between the day an appointment was requested and the date of the appointment, skip if not applicable

JeffCare Satisfaction Survey

Question Title

* 1. Optional, contact information

Question Title

* 2. Which JeffCare Health Center are you providing feedback for?

Question Title

* 3. Which service(s) did you receive today

Question Title

* 4. Ease of intake and registration as a new patient, skip if not applicable

Question Title

* 5. Helpfulness of the staff checking me in for my appointment, skip if not applicable

Question Title

* 6. Waiting time to check-in, skip if not applicable

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* 7. Comfort of the waiting area/lobby, skip if not applicable

Question Title

* 8. Feedback/comments on Administrative Support staff

Question Title

* 9. Helpfulness of nursing staff, skip if not applicable

Question Title

* 10. Trust in the skills of the nursing staff assisting you before seeing the provider, skip if not applicable

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* 11. Feedback/comment on nursing staff

Question Title

* 12. Satisfaction with your provider’s explanation of treatment/plan, skip if not applicable

Question Title

* 13. Treatment provider(s) provided me with an opportunity to ask questions, skip if not applicable

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* 14. Satisfaction with your provider(s) concern for your treatment, skip if not applicable

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* 15. Your trust in the skill of the provider(s) who provided your treatment, skip if not applicable

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* 16. Feedback/comment on treatment provider staff

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* 17. Staff members you interacted with treated you with respect and dignity

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* 18. Overall satisfaction with Covid precautions (staff wearing masks, distancing, signs posted with expectations, etc.)

Question Title

* 19. Responsiveness to any concerns/complaints reported during your visit, skip if not applicable

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* 20. Overall satisfaction with how well the staff worked together to provide your care

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* 21. Likeliness of you recommending JeffCare services to others

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* 22. Overall satisfaction with the average length of time between the day an appointment was requested and the date of the appointment, skip if not applicable

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* 23. Would you be interested in before-hours appointment times (7-8am)?

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* 24. Would you be interested in after-hours appointments (5-6 pm)?