Patient Satisfaction Survey

Thank you for taking the time to participate in our patient satisfaction survey. Providing excellent service is our top priority at Christian Community Health Center (CCHC). Your responses will assist CCHC to better serve you in the future. Please be assured that all answers you provide will be kept strictly confidential.
 
This survey should take less than 5 minutes to complete.
 
If you have any questions or comments, please contact the Director, Deborah Johnson at djohnson@cchc1.org.

HIPPA Privacy Act Policy

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* 1. At which CCHC location do you receive the majority of your health care services? (please select one)

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* 2. Which CCHC health care services do you receive? (please select all that apply)

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* 3. What is your age range? (please select one) 

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* 4. What ethnicity do you identify with? (please check one)

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* 5. What race do you most identify with? (please check all that apply)

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* 6. What is your gender identity?  (please check one)

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* 7. How long have you been receiving medical services at CCHC? (please check one)

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* 8. Please tell us how well we are doing in our health care programsin the following areas: Access, Coordination of Care/Services, Communication, and Well-being/Care/Support (please select a rating for each statement/question)

  GREAT GOOD OK FAIR POOR N/A
Access: Ability to get an appointment to be seen
Access: Hours the clinic is open
Access: Amount of wait time in the reception area/lobby
Access: Amount of wait time in exam room
Coordination of Care/Service: You received your referrals in a timely manner
Coordination of Care/Service: Staff/Provider explained the services you received (i.e. prescriptions, lab results or referrals)
Communication: Your phone calls, requests or questions were answered promptly
Communication: Staff/Provider was willing to listen to you
Communication: Staff/Provider explained things to you in a way you understood
Communication: Staff/Provider treated you with courtesy or respect
Well-Being/Care/Support: Staff/Provider talked with and supported you with your healthcare decisions, goals or activities
Well-Being/Care/Support: Overall, how would you rate the health care services you've received from CCHC?

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* 9. Please answer the following questions regarding medical services.

  Yes No
Do the services you receive from CCHC address your immediate needs?
Do you consider CCHC to be your primary source for health care services?

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* 10. Comments:

T