Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. EXIT SCHC Patient Satisfaction Survey Question Title * 1. Please rate your overall experience today 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied Comments/Details: OK Question Title * 2. Which provider did you see today? Jeanette Nienaber, PA-C I don't know Dr. Harsha Gowtham Christie Griffin, ANP Ed Gonzalez, FNP Clinic Nurse Dr. Becki Schellinger Sam Johnson, LCSW Andrea Helmer, ANP Chrissy Forgione, LCSW Gina Catley, LCSW Other (please specify) OK Question Title * 3. When making your appointment, were you given a chance to see your primary care provider? Yes No N/A I don't have a primary care provider Comments/Details: OK Question Title * 4. How satisfied were you with the appointment time you were able to get? 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied Comments/details: OK Question Title * 5. How satisfied were you with the following? 1 Not satisfied at all 2 3 4 5 Extremely satisfied N/A Front desk staff knowledge & friendliness Front desk staff knowledge & friendliness 1 Not satisfied at all Front desk staff knowledge & friendliness 2 Front desk staff knowledge & friendliness 3 Front desk staff knowledge & friendliness 4 Front desk staff knowledge & friendliness 5 Extremely satisfied Front desk staff knowledge & friendliness N/A Nursing staff knowledge & friendliness Nursing staff knowledge & friendliness 1 Not satisfied at all Nursing staff knowledge & friendliness 2 Nursing staff knowledge & friendliness 3 Nursing staff knowledge & friendliness 4 Nursing staff knowledge & friendliness 5 Extremely satisfied Nursing staff knowledge & friendliness N/A Provider knowledge & friendliness Provider knowledge & friendliness 1 Not satisfied at all Provider knowledge & friendliness 2 Provider knowledge & friendliness 3 Provider knowledge & friendliness 4 Provider knowledge & friendliness 5 Extremely satisfied Provider knowledge & friendliness N/A Cleanliness of the clinic Cleanliness of the clinic 1 Not satisfied at all Cleanliness of the clinic 2 Cleanliness of the clinic 3 Cleanliness of the clinic 4 Cleanliness of the clinic 5 Extremely satisfied Cleanliness of the clinic N/A Comments/details: OK Question Title * 6. How would you rate the length of time you spent waiting during today's visit? Too short About the right length Too long Comments/details: OK Question Title * 7. How satisfied were you with the amount of time your provider spent with you addressing your needs? Too short About the right length Too long Comments/details: OK Question Title * 8. Is there anyone on our team you would like to recognize or thank for how they cared for you today? No Yes OK Question Title * 9. Are any of these keeping you from reaching your physical and mental wellness goals? None Cost / too expensive I don't have insurance/enough coverage Transportation Access to nutritious foods Access to clean water and utilities (e.g., electricity, sanitation, heating) Lack of family and/or social support Other (please specify) OK Question Title * 10. Is there anything we could have done to improve your visit today? No Yes OK DONE
