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 TB Other (please specify) OK Question Title * 2. Did you have difficulty getting an appointment Yes No OK 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? Yes No N/A OK Question Title * 4. Did you understand the information you were given today? Yes No OK Question Title * 5. Convenience of the location of the office? Excellent Good Fair Poor N/A OK Question Title * 6. Length of time waiting at office? Excellent Good Fair Poor N/A OK Question Title * 7. Time spent with person/people you saw? Excellent Good Fair Poor N/A OK Question Title * 8. Explanation of what was done for you? Excellent Good Fair Poor N/A OK Question Title * 9. The technical skills (thoroughness,carefulness, competence) of the person you saw? Excellent Good Fair Poor N/A OK Question Title * 10. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw? Excellent Good Fair Poor N/A OK Question Title * 11. Office hours suitable to your needs? Excellent Good Fair Poor N/A OK Question Title * 12. Comments: OK DONE