Knox County Community Health Center Patient Satisfaction Survey

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* 1. What service did you receive today?

Medical

Dental

Behavioral Health

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* 2. Overall, how would you rate your visit today?

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* 3. In general, how would you rate your overall health?

Excellent

Good

Fair

Poor

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* 4. Ease of Getting Care

	Excellent	Good	Fair	Poor
Able to easily get an appointment for checkups (yearly exams, well-visits, follow-ups)	Able to easily get an appointment for checkups (yearly exams, well-visits, follow-ups) Excellent	Able to easily get an appointment for checkups (yearly exams, well-visits, follow-ups) Good	Able to easily get an appointment for checkups (yearly exams, well-visits, follow-ups) Fair	Able to easily get an appointment for checkups (yearly exams, well-visits, follow-ups) Poor
Able to easily same day appointments when sick or hurt	Able to easily same day appointments when sick or hurt Excellent	Able to easily same day appointments when sick or hurt Good	Able to easily same day appointments when sick or hurt Fair	Able to easily same day appointments when sick or hurt Poor
Health center hours work for me and my schedule	Health center hours work for me and my schedule Excellent	Health center hours work for me and my schedule Good	Health center hours work for me and my schedule Fair	Health center hours work for me and my schedule Poor
Phone calls are returned quickly	Phone calls are returned quickly Excellent	Phone calls are returned quickly Good	Phone calls are returned quickly Fair	Phone calls are returned quickly Poor
I am able to contact someone or get information when the office is closed	I am able to contact someone or get information when the office is closed Excellent	I am able to contact someone or get information when the office is closed Good	I am able to contact someone or get information when the office is closed Fair	I am able to contact someone or get information when the office is closed Poor
The length of time waiting at clinic	The length of time waiting at clinic Excellent	The length of time waiting at clinic Good	The length of time waiting at clinic Fair	The length of time waiting at clinic Poor

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* 5. Which facility did you visit today?

Knox County Dental

Knox County Community Health Center

Danville Community Health Center

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* 6. Facility

	Yes	No	Does not apply
The clinic is easy to find	The clinic is easy to find Yes	The clinic is easy to find No	The clinic is easy to find Does not apply
The waiting area was comfortable and clean	The waiting area was comfortable and clean Yes	The waiting area was comfortable and clean No	The waiting area was comfortable and clean Does not apply
The exam room was comfortable and clean	The exam room was comfortable and clean Yes	The exam room was comfortable and clean No	The exam room was comfortable and clean Does not apply
The facility is handicap accessible	The facility is handicap accessible Yes	The facility is handicap accessible No	The facility is handicap accessible Does not apply

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* 7. Front Desk

	Yes	No	Does not apply
Front office staff was friendly and helpful	Front office staff was friendly and helpful Yes	Front office staff was friendly and helpful No	Front office staff was friendly and helpful Does not apply
Billing staff/front office staff was able to fully explain my payment options to me	Billing staff/front office staff was able to fully explain my payment options to me Yes	Billing staff/front office staff was able to fully explain my payment options to me No	Billing staff/front office staff was able to fully explain my payment options to me Does not apply
I feel the care is worth what I pay	I feel the care is worth what I pay Yes	I feel the care is worth what I pay No	I feel the care is worth what I pay Does not apply

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* 8. Nurses and Medical Assistants

	Yes	No	Does not apply
Listen to me and answer any questions	Listen to me and answer any questions Yes	Listen to me and answer any questions No	Listen to me and answer any questions Does not apply
Friendly and helpful	Friendly and helpful Yes	Friendly and helpful No	Friendly and helpful Does not apply

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* 9. Providers (doctor, nurse practitioner, dentist, counselor)

	Yes	No	Does not apply
Listens to me and answers any questions	Listens to me and answers any questions Yes	Listens to me and answers any questions No	Listens to me and answers any questions Does not apply
Spent enough time with me	Spent enough time with me Yes	Spent enough time with me No	Spent enough time with me Does not apply
Friendly and helpful	Friendly and helpful Yes	Friendly and helpful No	Friendly and helpful Does not apply
Considers my personal and/or family beliefs when discussing my care	Considers my personal and/or family beliefs when discussing my care Yes	Considers my personal and/or family beliefs when discussing my care No	Considers my personal and/or family beliefs when discussing my care Does not apply
Explains the plan for my care in a way I can understand	Explains the plan for my care in a way I can understand Yes	Explains the plan for my care in a way I can understand No	Explains the plan for my care in a way I can understand Does not apply
Helps me set goals for my health	Helps me set goals for my health Yes	Helps me set goals for my health No	Helps me set goals for my health Does not apply
I usually see the same provider for each visit	I usually see the same provider for each visit Yes	I usually see the same provider for each visit No	I usually see the same provider for each visit Does not apply

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* 10. Today's Visit

	Yes	No	Does not apply
Did you have problems traveling to the facility?	Did you have problems traveling to the facility? Yes	Did you have problems traveling to the facility? No	Did you have problems traveling to the facility? Does not apply
Did you have problems being able to pay for today's visit?	Did you have problems being able to pay for today's visit? Yes	Did you have problems being able to pay for today's visit? No	Did you have problems being able to pay for today's visit? Does not apply
Did someone discuss your goals for your health with you?	Did someone discuss your goals for your health with you? Yes	Did someone discuss your goals for your health with you? No	Did someone discuss your goals for your health with you? Does not apply
Did you get a copy of your care plan?	Did you get a copy of your care plan? Yes	Did you get a copy of your care plan? No	Did you get a copy of your care plan? Does not apply
Did your provider review your medications with you?	Did your provider review your medications with you? Yes	Did your provider review your medications with you? No	Did your provider review your medications with you? Does not apply
Did the front office staff help schedule any follow up appointments or additional appointments?	Did the front office staff help schedule any follow up appointments or additional appointments? Yes	Did the front office staff help schedule any follow up appointments or additional appointments? No	Did the front office staff help schedule any follow up appointments or additional appointments? Does not apply

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* 11. General

	Yes	No	Does not apply
Do you consider the Knox County Community Health Center your "medical home" (you come here for the majority of your basic care)	Do you consider the Knox County Community Health Center your "medical home" (you come here for the majority of your basic care) Yes	Do you consider the Knox County Community Health Center your "medical home" (you come here for the majority of your basic care) No	Do you consider the Knox County Community Health Center your "medical home" (you come here for the majority of your basic care) Does not apply
You may need additional services we do not provide, have we helped you find other services you need?	You may need additional services we do not provide, have we helped you find other services you need? Yes	You may need additional services we do not provide, have we helped you find other services you need? No	You may need additional services we do not provide, have we helped you find other services you need? Does not apply
Do we help you feel empowered to make healthier lifestyle choices?	Do we help you feel empowered to make healthier lifestyle choices? Yes	Do we help you feel empowered to make healthier lifestyle choices? No	Do we help you feel empowered to make healthier lifestyle choices? Does not apply
Would you send your family or friends to us?	Would you send your family or friends to us? Yes	Would you send your family or friends to us? No	Would you send your family or friends to us? Does not apply

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* 12. Is there any reason you would not recommend us to friends and family?

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* 13. If you were not able to make your last visit, what would you consider the main reason for not being able to make your visit?

Transportation

Financial Hardship

No phone service

Sickness

Other (please specify)

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* 14. What is one thing the health center could do to improve your next visit with us?

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* 15. If you have visited the health department for other services (Environmental Health, Birth or Death Certificates, health department programs, etc.), please let us know

Great - Keep up the good work!

OK - Better than I expected for a government agency

Not good - I was expecting more

Bad - My people need to talk with your people

None of the above

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* 16. If you answered, "not good" or "bad" would you please share what we could have done better for you today?'

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* 17. What is your age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 18. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 19. Are you Hispanic or Latino?

Yes

Knox County Community Health Center Patient Satisfaction Survey

Question Title

* 1. What service did you receive today?

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* 2. Overall, how would you rate your visit today?

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* 3. In general, how would you rate your overall health?

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* 4. Ease of Getting Care

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* 5. Which facility did you visit today?﻿

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* 6. Facility

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* 7. Front Desk

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* 8. Nurses and Medical Assistants

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* 9. Providers (doctor, nurse practitioner, dentist, counselor)

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* 10. Today's Visit

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* 11. General

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* 12. Is there any reason you would not recommend us to friends and family?

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* 13. If you were not able to make your last visit, what would you consider the main reason for not being able to make your visit?

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* 14. What is one thing the health center could do to improve your next visit with us?

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* 15. If you have visited the health department for other services (Environmental Health, Birth or Death Certificates, health department programs, etc.), please let us know

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* 16. If you answered, "not good" or "bad" would you please share what we could have done better for you today?'

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* 17. What is your age

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* 18. What is your race?

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* 19. Are you Hispanic or Latino?

* 5. Which facility did you visit today?