September 2026 Patient Satisfaction Survey

We would like to know how you feel about the services and care you receive at Grace Medical Home. This information will be used to improve our services. This survey is optional, and your answers will be kept confidential.

1.Please indicate how well you think we are doing in the following areas?

Poor/ Strongly Disagree

Fair/ Disagree

Okay/ Neutral

Good/ Agree

Great/ Strongly Agree

N/A

2.If Grace Medical Home was not an option, where would you most likely go for healthcare? (check one box)

Health Clinic (like TrueHealth, Community Health Centers, Orange Blossom Family Health, etc.)

Doctor’s Office

Urgent Care Clinic (Centra Care or Minute Clinic)

Emergency Room

Would not get care

If emergency room, which one?

3.If Grace Medical Home was not an option, where would you most likely get your medications?

Buy at Publix, Walmart, Target.

Buy at a drug store like CVS, Walgreens, etc.

Get through mail order service.

Try to get it from the drug manufacturer or other assistance program.

I would go without medications.

4.If Grace Medical Home was not an option, where would you most likely go for dental care?

Dental Clinic (like TrueHealth, Community Health Centers, Orange Blossom Family Health, etc.)

Dentist’s Office

Emergency Room

Would not get care

Please specify

If emergency room, which one?

5.Before you became a patient, how did you hear about Grace Medical Home? If you heard about us from more than one source, check the one that had the most impact on your decision to enroll.

Non-profit/service agency (please enter its name below):

6.If you heard about Grace Medical Home from some other way, what was it?

7.We are accepting new pediatric patients (between age 0 – 18). Do you know a family that might want their children to be patients at Grace? If you know their contact information, write it here:

Or ask the front desk team to give you information for you to give to the family.

8.Grace wants to avoid “no show” appointments where a patient does not show up for the visit or cancel it with enough time to reschedule others. If you have had an appointment this year that you couldn’t attend and/or didn’t call to cancel, please indicate the reason/s. (Check the biggest reason you couldn’t attend.)

I had to work or couldn’t leave.

I had no way to get there.

I had no childcare to care for my kids.

I didn’t think I needed that appointment

I forgot/didn’t know I had an appointment.

I couldn’t afford the facility fee.

I was worried about ICE activity.

Other (please specify):

9.Have you had an appointment with a Grace Medical Home provider using the telehealth video call system or phone?

No, I have not had a telehealth/phone visit or I can’t remember.

Yes, I have had an appointment using the telehealth system or phone.