HCHD Patient/Consumer Satisfaction Survey Question Title * 1. Time of Visit: Morning (8:00-12:00) Afternoon (1:00-5:00) OK Question Title * 2. Are you: Male Female OK Question Title * 3. What is your age? Under 18 18-24 25-34 35-44 45-54 55-64 65-75 Over 75 OK Question Title * 4. Which of the following best describes your racial or ethnic background? Black Asian Hispanic American Indian White Other (please specify) OK Question Title * 5. The Health Department is open from 8:00am-5:00pm. Are the hours of operation convenient for you? These hours are good for me Health Department should be open earlier than 8:00am Health Department should close later than 5:00pm There should be extended hours. Other (please specify) OK Question Title * 6. Why did you choose the Health Department for your health care? Please check all that apply. Recommended by a friend Cost Confidentiality/Privacy Convenient hours Location Quality of Care Provided OK Question Title * 7. Thinking about your visit, how would you rate the following (Fill in only one check box for each item). Excellent Good Fair Poor Privacy Provided Privacy Provided Excellent Privacy Provided Good Privacy Provided Fair Privacy Provided Poor Length of wait time Length of wait time Excellent Length of wait time Good Length of wait time Fair Length of wait time Poor Quality of Care provided Quality of Care provided Excellent Quality of Care provided Good Quality of Care provided Fair Quality of Care provided Poor Cleanliness of building Cleanliness of building Excellent Cleanliness of building Good Cleanliness of building Fair Cleanliness of building Poor Directional Signs in the building Directional Signs in the building Excellent Directional Signs in the building Good Directional Signs in the building Fair Directional Signs in the building Poor OK Question Title * 8. During your visit do you feel that our staff treated you with respect? Yes No OK Question Title * 9. Have you ever accessed your Harnett County Health Department Patient Portal? Yes No OK Question Title * 10. What was the reason for your visit? Child Health Clinic Immunization Child Immunization Adult WIC Employee Health Prenatal Environmental Health Division on Aging Family Planning STD Social Work Other (please specify) OK Question Title * 11. How satisfied were you with the ease of making an appointment? Very satisfied Satisfied Neutral Unsatisfied Very dissatisfied OK Question Title * 12. Would you recommend the Harnett County Health Department to your family and friends? Yes No OK Question Title * 13. How satisfied were you with your visit? Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied OK Question Title * 14. Did you use interpreter services today? Yes No OK Question Title * 15. How satisfied were you with the availability of interpreter services during the clinic visit? Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied I did not use an interpreter OK Question Title * 16. Rate your ability to understand the information provided by the nurse or provider today. Very good Good Fair Poor Very Poor OK Question Title * 17. Comments OK DONE