Help us make your experience at ANHC great -- let us know how we are doing

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1. Date (Of visit or appointment) at ANHC:

Date

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2. Name(s) of staff who worked with you:

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3. Are you a Ryan White (RW) patient/consumer?

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4. Please rate the statements about your recent visit to ANHC:
The location is convenient for receiving my care.

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5. Please rate the statements about your recent visit to ANHC:
The Center hours work with my schedule.

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6. Please rate the statements about your recent visit to ANHC:
It was easy for me to make an appointment at ANHC.

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7. Please rate the statements about your recent visit to ANHC:
ANHC staff answered all of my questions in a timely fashion.

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8. Please rate the statements about your recent visit to ANHC:
I understood the way my provider explained things to me.

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9. Please rate the statements about your recent visit to ANHC:
I felt like my provider spent enough time with me.

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10. Please rate the statements about your recent visit to ANHC:
ANHC staff were helpful and treated me with respect.

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11. Please rate the statements about your recent visit to ANHC:
ANHC staff gave me excellent customer service.

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12. Please rate the statements about your recent visit to ANHC:
Receiving my care (medical and dental) is affordable.

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13. I am aware that, depending on the visit reason, telehealth is an option (NOT for dental services).

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14. Rate how your felt about your overall experience during this visit (5=Best, 1=Worst).

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15. Please leave any comments below

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16. Please check yes below if you want someone from the Anchorage Neighborhood Health Center to call you regarding your experience?

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