2024 Health Center Patient Satisfaction Survey

Question Title

* 1. Approximately how long have you been receiving services from the CSS Health Center?

3 months or less

3 months - 1 year

1-3 years

3-5 years

More than 5 years

Question Title

* 2. Access to Care

	Great	Good	OK	Fair	Poor	N/A
Able to get an appointment	Able to get an appointment Great	Able to get an appointment Good	Able to get an appointment OK	Able to get an appointment Fair	Able to get an appointment Poor	Able to get an appointment N/A
Convenient hours of operation	Convenient hours of operation Great	Convenient hours of operation Good	Convenient hours of operation OK	Convenient hours of operation Fair	Convenient hours of operation Poor	Convenient hours of operation N/A
Prompt return of phone calls	Prompt return of phone calls Great	Prompt return of phone calls Good	Prompt return of phone calls OK	Prompt return of phone calls Fair	Prompt return of phone calls Poor	Prompt return of phone calls N/A
Convenience of Health Center location	Convenience of Health Center location Great	Convenience of Health Center location Good	Convenience of Health Center location OK	Convenience of Health Center location Fair	Convenience of Health Center location Poor	Convenience of Health Center location N/A
Explanation of charges/fees	Explanation of charges/fees Great	Explanation of charges/fees Good	Explanation of charges/fees OK	Explanation of charges/fees Fair	Explanation of charges/fees Poor	Explanation of charges/fees N/A

Question Title

* 3. Facility / Waiting Area

	Great	Good	OK	Fair	Poor	N/A
Neat, clean, and comfortable building	Neat, clean, and comfortable building Great	Neat, clean, and comfortable building Good	Neat, clean, and comfortable building OK	Neat, clean, and comfortable building Fair	Neat, clean, and comfortable building Poor	Neat, clean, and comfortable building N/A
Accessible for persons with physical limitations/disabilities	Accessible for persons with physical limitations/disabilities Great	Accessible for persons with physical limitations/disabilities Good	Accessible for persons with physical limitations/disabilities OK	Accessible for persons with physical limitations/disabilities Fair	Accessible for persons with physical limitations/disabilities Poor	Accessible for persons with physical limitations/disabilities N/A
Provides a safe environment	Provides a safe environment Great	Provides a safe environment Good	Provides a safe environment OK	Provides a safe environment Fair	Provides a safe environment Poor	Provides a safe environment N/A
Time in waiting room	Time in waiting room Great	Time in waiting room Good	Time in waiting room OK	Time in waiting room Fair	Time in waiting room Poor	Time in waiting room N/A
Time in exam room	Time in exam room Great	Time in exam room Good	Time in exam room OK	Time in exam room Fair	Time in exam room Poor	Time in exam room N/A

Question Title

* 4. Staff Interaction

	Great	Good	OK	Fair	Poor	N/A
Listens to you	Listens to you Great	Listens to you Good	Listens to you OK	Listens to you Fair	Listens to you Poor	Listens to you N/A
Takes enough time with you	Takes enough time with you Great	Takes enough time with you Good	Takes enough time with you OK	Takes enough time with you Fair	Takes enough time with you Poor	Takes enough time with you N/A
Answers your questions	Answers your questions Great	Answers your questions Good	Answers your questions OK	Answers your questions Fair	Answers your questions Poor	Answers your questions N/A
Friendly and helpful	Friendly and helpful Great	Friendly and helpful Good	Friendly and helpful OK	Friendly and helpful Fair	Friendly and helpful Poor	Friendly and helpful N/A
Confidentiality and privacy respected	Confidentiality and privacy respected Great	Confidentiality and privacy respected Good	Confidentiality and privacy respected OK	Confidentiality and privacy respected Fair	Confidentiality and privacy respected Poor	Confidentiality and privacy respected N/A

Question Title

* 5. My health has improved since coming to the CSS Health Center.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 6. Please indicate if you are interested in receiving any of these additional services through the CSS Health Center.

Dental

Vision

Podiatry

Dietician / Nutrition Education

Smoking Cessation Counseling

Healthy Lifestyle Education / Walking

Other (please specify)

Question Title

* 7. What do you like best about the CSS Health Center?

Question Title

* 8. What do you like least about the CSS Health Center?

Question Title

* 9. Are you of Spanish, Hispanic or Latino origin or descent?

Yes

Question Title

* 10. Please indicate your gender:

Male

Female

Transgender (Male to Female)

Transgender (Female to Male)

Gender non-conforming

I prefer not to answer

Other (please specify)

Question Title

* 11. Race: Please mark one or all that you consider yourself to be:

Alaskan Native/American Indian

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

I prefer not to answer

None of the above, please specify

Question Title

* 12. What is your sexual orientation?

Straight/Heterosexual

Gay or Lesbian

Bisexual

Queer

Pansexual

Questioning

Asexual

I prefer not to answer

None of the above, please specify

2024 Health Center Patient Satisfaction Survey

Question Title

* 1. Approximately how long have you been receiving services from the CSS Health Center?

Question Title

* 2. Access to Care

Question Title

* 3. Facility / Waiting Area

Question Title

* 4. Staff Interaction

Question Title

* 5. My health has improved since coming to the CSS Health Center.

Question Title

* 6. Please indicate if you are interested in receiving any of these additional services through the CSS Health Center.

Question Title

* 7. What do you like best about the CSS Health Center?

Question Title

* 8. What do you like least about the CSS Health Center?

Question Title

* 9. Are you of Spanish, Hispanic or Latino origin or descent?

Question Title

* 10. Please indicate your gender:

Question Title

* 11. Race: Please mark one or all that you consider yourself to be:

Question Title

* 12. What is your sexual orientation?

Question Title

* 13. Suggestions for Improvement?