CUSTOMER SERVICE QUESTIONNAIRE Survey

1. Please answer the following questions:

Community Medical Center is committed to you, from day one. To deliver a continuum of services that exceed your expectations, we need to hear from. Your input is extremely valuable to us, so please take a moment to fill out this brief survey. Thank you!

1. Contact information:
(Email required for prize entry)

Contact information: (Email required for prize entry) Name:
City/Town:
State:
Email Address:

2. Are you Male or Female?

Are you Male or Female? Male

Female

3. What is your age?

What is your age?

4. What is your race?

What is your race?

5. What is the highest level of education you have completed?

What is the highest level of education you have completed?

6. What is your total household income?

What is your total household income?

7. What is the approximate annual healthcare expenditure for your household?

What is the approximate annual healthcare expenditure for your household? Less than $10,000 / yr

$10,000 - $19,999 / yr

$20,000 - $29,999 / yr

More than $30,000 / yr

8. What percentage of your family's healthcare does Community Medical Center provide?

What percentage of your family's healthcare does Community Medical Center provide? 0% - 25%

25% - 50%

50% - 75%

75% - 100%

9. In your own words, what quality makes Community Medical Center so unique?

In your own words, what quality makes Community Medical Center so unique?

10. How often do you visit www.communitymed.org?

How often do you visit www.communitymed.org? Daily

Weekly

Monthly

Every once in awhile

Never

11. What do you currently use this website for the most? (check all that apply)

What do you currently use this website for the most? (check all that apply) For general contact information

To view the hospital calendar

To locate and learn about physicians

To pay my bill

To learn about the hospital

To learn about medical services

To search for careers and opportunities

I don't visit this website

To read recent news and events

12. How important are the following functions when using this website?

	Very Important	Important	Doesn't Matter	Not important	Very unimportant
Help me find the right doctor	How important are the following functions when using this website? Help me find the right doctor Very Important	Help me find the right doctor Important	Help me find the right doctor Doesn't Matter	Help me find the right doctor Not important	Help me find the right doctor Very unimportant
Provide information on hospital-related news and events	Provide information on hospital-related news and events Very Important	Provide information on hospital-related news and events Important	Provide information on hospital-related news and events Doesn't Matter	Provide information on hospital-related news and events Not important	Provide information on hospital-related news and events Very unimportant
Show job postings and career opportunities	Show job postings and career opportunities Very Important	Show job postings and career opportunities Important	Show job postings and career opportunities Doesn't Matter	Show job postings and career opportunities Not important	Show job postings and career opportunities Very unimportant
Make it easy for me to contact the right person	Make it easy for me to contact the right person Very Important	Make it easy for me to contact the right person Important	Make it easy for me to contact the right person Doesn't Matter	Make it easy for me to contact the right person Not important	Make it easy for me to contact the right person Very unimportant
Pay my bill online	Pay my bill online Very Important	Pay my bill online Important	Pay my bill online Doesn't Matter	Pay my bill online Not important	Pay my bill online Very unimportant

13. What would cause you to use this website more frequently? (Choose the answer that is most important to you)

What would cause you to use this website more frequently? (Choose the answer that is most important to you) Tools to interact with hospital staff

Ability to learn about treatment options

Healthy living resources and tips

Easier to navigate

Current and relevant content

14. Please rate the following statements about this website:

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
I can find the information I'm looking for.	Please rate the following statements about this website: I can find the information I'm looking for. Strongly Agree	I can find the information I'm looking for. Agree	I can find the information I'm looking for. Neither Agree nor Disagree	I can find the information I'm looking for. Disagree	I can find the information I'm looking for. Strongly Disagree
The content is current and relevant.	The content is current and relevant. Strongly Agree	The content is current and relevant. Agree	The content is current and relevant. Neither Agree nor Disagree	The content is current and relevant. Disagree	The content is current and relevant. Strongly Disagree
There is an appropriate amount of text.	There is an appropriate amount of text. Strongly Agree	There is an appropriate amount of text. Agree	There is an appropriate amount of text. Neither Agree nor Disagree	There is an appropriate amount of text. Disagree	There is an appropriate amount of text. Strongly Disagree

CUSTOMER SERVICE QUESTIONNAIRE