Adult Survey

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.

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* 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.

  1 2 3 4 5 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.
At which location did you receive services today?

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

What type of service did you receive today?

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

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