Robeson County Health Department Client Satisfaction Survey

Question Title

* 1. Reason for Visit:

Adult Primary Care

Child Health

Family Planning

Infectious Disease

Immunizations

Maternity

Nurse Family Partnership (NFP)

STD

Other (please specify)

Question Title

* 2. Did you have difficulty getting an appointment

Yes

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* 3. If you were requesting an appointment due to having signs and symptoms of illness, did we see you (by appointment) within the next 24 hours?

Yes

N/A

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* 4. Did you understand the information you were given today?

Yes

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* 5. Convenience of the location of the office?

Excellent

Good

Fair

Poor

N/A

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* 6. Length of time waiting at office?

Excellent

Good

Fair

Poor

N/A

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* 7. Time spent with person/people you saw?

Excellent

Good

Fair

Poor

N/A

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* 8. Explanation of what was done for you?

Excellent

Good

Fair

Poor

N/A

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* 9. The technical skills (thoroughness,carefulness, competence) of the person you saw?

Excellent

Good

Fair

Poor

N/A

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* 10. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw?

Excellent

Good

Fair

Poor

N/A

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* 11. Office hours suitable to your needs?

Excellent

Good

Fair

Poor

N/A

Robeson County Health Department Client Satisfaction Survey

Question Title

* 1. Reason for Visit:

Question Title

* 2. Did you have difficulty getting an appointment

Question Title

* 3. If you were requesting an appointment due to having signs and symptoms of illness, did we see you (by appointment) within the next 24 hours?

Question Title

* 4. Did you understand the information you were given today?

Question Title

* 5. Convenience of the location of the office?

Question Title

* 6. Length of time waiting at office?

Question Title

* 7. Time spent with person/people you saw?

Question Title

* 8. Explanation of what was done for you?

Question Title

* 9. The technical skills (thoroughness,carefulness, competence) of the person you saw?

Question Title

* 10. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw?

Question Title

* 11. Office hours suitable to your needs?

Question Title

* 12. Comments: