Patient Experience Questions

Please complete the survey about your most recent visit to a CHSA health center.  Thank you for your participation.

Is the appointment you are reviewing today within the last -

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* 1. Is the appointment you are reviewing today within the last -

When you called to schedule an appointment to be seen right away, when were you seen?

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* 2. When you called to schedule an appointment to be seen right away, when were you seen?

How often did this provider explain things in a way that was easy to understand?

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* 3. How often did this provider explain things in a way that was easy to understand?

Did anyone in this provider's office talk with you about specific goals for your health?

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* 4. Did anyone in this provider's office talk with you about specific goals for your health?

Did you see a specialist for a particular health problem? Specialists are doctors like surgeons, heart doctors, OB-GYNs, allergy doctors, skin doctors, and other doctors who specialize in one area of health care.

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* 5. Did you see a specialist for a particular health problem? Specialists are doctors like surgeons, heart doctors, OB-GYNs, allergy doctors, skin doctors, and other doctors who specialize in one area of health care.

How often did your provider seem informed and up-to-date about the care you got from the specialists?

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* 6. How often did your provider seem informed and up-to-date about the care you got from the specialists?

Would you recommend this health center to someone else?

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* 7. Would you recommend this health center to someone else?

How did you hear about the health center?

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* 8. How did you hear about the health center?

How was your experience when you called your health center?  (1 being the worst and 10 being the best)

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* 9. How was your experience when you called your health center?  (1 being the worst and 10 being the best)

Do you consider yourself White, Black or African American, Hispanic or Latino, Asian or some other race-ethnic group?

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* 10. Do you consider yourself White, Black or African American, Hispanic or Latino, Asian or some other race-ethnic group?

Indicate below your Primary Care Provider (PCP) at your health center.  If you cannot remember your PCP's name, please list the location where you were seen.

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* 11. Indicate below your Primary Care Provider (PCP) at your health center.  If you cannot remember your PCP's name, please list the location where you were seen.

Any other comments you would like to share about the health center?

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* 12. Any other comments you would like to share about the health center?

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