Adult Survey

* 1. Using the scale from 1 to 5 with 1 being NEVER and 5 being ALWAYS rate your visit today in the following areas? Please, only choose one per line.

  Never 1 2 3 4 5 Always Not Applicable
I see my preferred provider during visits.
I am asked about follow-up from my last visit.
I understand the medications ordered by my provider. 
I am asked if I need other services offered at the clinic. 
I receive phone calls about my test results. 
I receive reminders about my appointments. 
I receive help making appointments needed at other health care providers. 
I receive follow-up at this clinic, after I am seen at another health care provider. 
I can access my medical information on my patient portal. 
I am on the sliding fee scale and I am able to pay for my visit. 

* 2. At which location did you receive services today? 

* 3. What type of service did you receive today? 

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