This survey is to assess the patient experience at HOPES and to help us improve our service delivery.
Patient age:

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* 1. Patient age:

My racial ethnic background is

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* 2. My racial ethnic background is

My sexual orientation is

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* 3. My sexual orientation is

My sex or gender is

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* 4. My sex or gender is

The services I have used at HOPES include (Check all that are applicable) 

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* 5. The services I have used at HOPES include (Check all that are applicable) 

Please evaluate the following statements.

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* 6. Please evaluate the following statements.

  Strongly Agree Agree Disagree Strongly Disgree Does Not Apply
The Pharmacy hours are convenient and work with my schedule
The pharmacy staff are friendly and courteous during my medication refill/pickup.
The Pharmacy provides my medication in a timely manner.
I am able to communicate with the pharmacy about my medication when needed.
What other services would you like to see at HOPES in the next couple of years?

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* 7. What other services would you like to see at HOPES in the next couple of years?

Thank you for helping with this survey. Please feel free to write additional comments/compliments here.

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* 8. Thank you for helping with this survey. Please feel free to write additional comments/compliments here.

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