Clinic Patient Satisfaction Survey Part 2 Question Title * 1. How satisfied are you with your service at the Reach Out Pharmacy? Poor Fair Average Good Beyond what I expected Poor Fair Average Good Beyond what I expected Question Title * 2. I would recommend Reach Out for those in need of medical services. Yes No If "No," why? Question Title * 3. Reach Out Clinics are available at convenient hours for my needs. Yes No If "No," would you prefer mornings or afternoons? Question Title * 4. I prefer to be contacted by: Home Phone Cell Phone Mailed Letter Question Title * 5. I always keep appointments (examples: x-ray's, labs, specialist visits). Yes No If "No," why? Question Title * 6. If you were unable to keep your appointment, did you cancel your appointment with the specialist or Reach Out? Yes No If "No," why? Question Title * 7. What would keep you from going to a specialist that Reach Out referred you to? Lack of transportation Financial resources Date/Time of appointment Don't feel it is necessary Family obligations/issues Work obligations/issues Other (please specify) Question Title * 8. What can Reach Out do to help you keep and attend a scheduled appointment? Reminder call Reminder text Reminder email Other (please specify) Question Title * 9. How do you rate Reach Out's customer service (volunteer/staff)? Poor Fair Average Good Beyond what I expected Poor Fair Average Good Beyond what I expected Question Title * 10. Do you have have problems with transportation? Yes No If so, why? What transportation do you use? Done