Patient Satisfaction Survey Your Health and Your Interactions with Staff Question Title * 1. How would you rate your overall health? Poor Fair Ok Good Great Poor Fair Ok Good Great OK Question Title * 2. How would you rate your health BEFORE coming to the Community Clinic? Poor Fair Ok Good Great Poor Fair Ok Good Great OK Question Title * 3. How would you rate your health AFTER coming to the Community Clinic? Poor Fair Ok Good Great Poor Fair Ok Good Great OK Question Title * 4. The provider (doctor, dentist, nurse practitioner, counselor, etc.) listens to me. Strongly disagree Disagree Somewhat Agree Strongly Agree Strongly disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 5. The provider (doctor, dentist, nurse practitioner, counselor, etc.) takes enough time with me. Strongly Disagree Disagree Somewhat Agree Strongly Agree Strongly Disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 6. The provider (doctor, dentist, nurse practitioner, counselor, etc.) explains what I need to know. Strongly Disagree Disagree Somewhat Agree Strongly Agree Strongly Disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 7. The provider (doctor, dentist, nurse practitioner, counselor, etc.) gives me good advice and treatment. Strongly Disagree Disagree Somewhat Agree Strongly Agree Strongly Disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 8. The nurses and medical assistants are friendly and helpful to me. Strongly disagree Disagree Somewhat Agree Strongly Agree Strongly disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 9. The front office staff members are friendly and they answer my questions effectively. Strongly Disagree Disagree Somewhat Agree Strongly Agree Strongly Disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 10. The Community Clinic has addressed my medical, dental, or counseling needs. Strongly Disagree Disagree Somewhat Agree Strongly Agree Strongly Disagree Disagree Somewhat Agree Strongly Agree OK Question Title * 11. What do you like best about the Community Clinic? OK Question Title * 12. How has the Community Clinic improved your life? OK Question Title * 13. What are your suggestions for improvement of the Community Clinic? OK Question Title * 14. What services have you received from the clinic? (check all that apply) Primary Care Cardiology Clinic Pulmonology Clinic Gynecology Clinic Dental Vision Assistance Pharmacy Lab Work Nutrition Cooking Classes Fitbit Group Counseling Patient Advocacy Diabetic Clinic Chiropractic Orthopedic Clinic Pediatrics Diabetic Education Tobacco Cessation Other (please specify) OK NEXT