Christian Community Health Center (CCHC) - Patient Satisfaction Survey

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. Which CCHC location did you visit for your most recent appointment? (please select one)

Halsted Clinic

Calumet City Clinic

South Holland Clinic

Telehealth (virtual)

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

Medical

Behavioral Health

Medical Case Management

Other (please specify)

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

Less than 18 years

19 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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

Hispanic, Latino

Non-Hispanic, non-Latino

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

White

Black, African-American

Asian

Native Hawaiian or other Pacific-Islander

American Indian or Alaska Native

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

Male

Female

Transgender

Prefer to self-describe:

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

< 6 months

6 months but less than a year

1 year but less than 3 years

3 years but less than 5 years

5 years or more

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

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

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

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* 1. Which CCHC location did you visit for your most recent appointment? (please select one)

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* 2. Which CCHC health care services did 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)

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

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* 10. What suggestions do you have for improving our health care services?