KCHC Patient Satisfaction Survey How Can We Improve? 2023 V1 Question Title * 1. In your recent experience(s), please rate your ability to be seen for an appointment as soon as you needed it. Very Satisfied Satisfied Neutral Unhappy Very Unhappy Very Satisfied Satisfied Neutral Unhappy Very Unhappy Comments: Question Title * 2. In your recent experience(s), please rate how well your healthcare provider explained your care. Were they easy to understand? Very Satisfied Satisfied Neutral Unhappy Very Unhappy Very Satisfied Satisfied Neutral Unhappy Very Unhappy Comments: Question Title * 3. In your recent experience(s), when a KCHC provider ordered a blood test, x-ray, or other test for you, how satisfied are you with the timeliness/communication about your results? Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Comments: Question Title * 4. Please rate KCHC staff on assistance with any problems/barriers you have to getting the healthcare you need. (For example: Transportation or language) Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Comments: Question Title * 5. Please rate your most recent experience with our Front Desk Staff. Very Satisfied Satisfied Neutral Unhappy Very Unhappy Very Satisfied Satisfied Neutral Unhappy Very Unhappy Comments: Question Title * 6. Please rate your most recent billing experience. Very Satisfied Satisfied Neutral Unhappy Very Unhappy Very Satisfied Satisfied Neutral Unhappy Very Unhappy Comments: Question Title * 7. Please rate your most recent experience with the person who assisted your KCHC provider. (For example: Registered Nurse, Medical Assistant, Licensed Practical Nurse) Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Comments: Question Title * 8. Please rate your most recent experience with your KCHC provider. (For Example: Doctor, Physicians Assistant, Nurse Practitioner, Dietitian, or Social Worker) Very Satisfied Satisfied Neutral Unhappy Very Unhappy Very Satisfied Satisfied Neutral Unhappy Very Unhappy Comments: Question Title * 9. Who was your KCHC provider for your most recent visit? Dr. Mortenson Dr. Silbergeld Dr. O'Grady Dr. Burnside Dr. Walters PA Holforty PA Witteveen PA Mete PA Linduska FNP Walker PMHNP Savannah RD Tony LCSW Crowe Other (please specify) Question Title * 10. If your visit was virtual/ Telehealth, please rate your experience with the technology. Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Very Satisfied Satisfied Neutral Unhappy Very Unhappy N/A Comments: Question Title * 11. Do you or your family qualify for our sliding fee scale? Yes No Declined to try Don't Know Question Title * 12. Is there anything else you would like us to know? Question Title * 13. Are there any KCHC staff members you'd like to honor, recognize, or thank on your behalf? Question Title * 14. May we contact you regarding any of your answers or comments above? Yes No Question Title * 15. If yes, please provide some contact information below. Name Email Address Phone Number Done