1. Patient Satisfaction 2022

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* 1. Location:

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* 2. Which provider did you see for your visit today?

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* 3. What is the age of the patient?

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* 4. What is your gender?

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* 5. During your visit how well did the staff respect your needs related to your gender:

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* 6. What is your sexual orientation?

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* 7. During your visit, how well did the staff respect your needs related to sexual orientation:

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* 8. Are you a new or returning patient?

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* 9. In the last six months was it easy to get the care, tests, or treatments you needed?

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* 10. Please indicate how well you think we are doing in the following areas:

Great- 5
Good- 4
Ok- 3
Fair- 2
Poor- 1

  5 4 3 2 1
 Ability to get in to be seen
Hours Center is open
Ease of registration process
Time in waiting room
Time waiting in exam room
Your provider/doctor listens to you
Your provider/doctor explains what you want to know
Health Center staff are friendly
Health Center building is neat and clean

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* 11. Are you currently receiving services under the sliding fee program?

T