Patient Satisfaction Web Survey - Immunization

This brief patient satisfaction survey is for persons who received services in any of The City of New York Immunization Clinics. The New York City Department of Health and Mental Hygiene wants to know how well they are satisfying their patients and where they should make improvements. Your honest feedback is very important.

Please be assured that your individual responses to the survey will be confidential and will only be shared with the New York City Department of Health and Mental Hygiene for the purposes of improving the quality of patient care and not for sales, marketing or fund raising. The goal of this survey is to improve services for patients.

As we go though the survey, please rate your experiences in this clinic only during your most recent visit, even if you had other services. Lets begin.

* 1. What is the date of your most recent clinic visit?


* 2. What is your age range?

* 3. What is your gender at birth?

* 4. From beginning to end, how long was your overall or total time in the clinic? Would you say...

* 5. Were you given an explanation for the delay?

* 6. Did you find the following area(s) clean:

  Yes No Don't Know Not Applicable
Waiting area(s)?
Examination room(s)?

* 7. If you received a vaccination at the clinic, did the patient care staff explain what the vaccination is for? Would you say...

* 8. Did you have any fears or concerns regarding your care?

* 9. Using any number from 0 to 10, where 0 is the worst possible care and 10 is the best possible care, what number would you use to rate the staff who cared for you?

* 10. In your opinion, did the clinic keep your personal health information private?

* 11. If applicable, did you receive language assistance services from the Health Department?

* 12. Were you satisfied with the language service assistance you received?

* 13.Thinking of this visit, what could the clinic have done better?

* 14. Would you recommend this clinic to your friends and family? Would you say...

Thank you for your time and for helping us serve you better!