September 2019 Dental Center Patient Survey

Question Title

* 1. Who did you see today? (Check all that apply)

Medical

Social Work

Dietician

Psychiatrist

Acupuncture

Counselor

Dental

Podiatrist

Pharmacy Staff

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
Facility was comfortable and clean	Facility was comfortable and clean Strongly Agree	Facility was comfortable and clean Agree	Facility was comfortable and clean Disagree	Facility was comfortable and clean Strongly Disagree	Facility was comfortable and clean Not Applicable
Staff and providers were friendly and helpful	Staff and providers were friendly and helpful Strongly Agree	Staff and providers were friendly and helpful Agree	Staff and providers were friendly and helpful Disagree	Staff and providers were friendly and helpful Strongly Disagree	Staff and providers were friendly and helpful Not Applicable
Health Center hours work for me	Health Center hours work for me Strongly Agree	Health Center hours work for me Agree	Health Center hours work for me Disagree	Health Center hours work for me Strongly Disagree	Health Center hours work for me Not Applicable
Phone calls get through easily	Phone calls get through easily Strongly Agree	Phone calls get through easily Agree	Phone calls get through easily Disagree	Phone calls get through easily Strongly Disagree	Phone calls get through easily Not Applicable
Length of time waiting at the clinic was appropriate	Length of time waiting at the clinic was appropriate Strongly Agree	Length of time waiting at the clinic was appropriate Agree	Length of time waiting at the clinic was appropriate Disagree	Length of time waiting at the clinic was appropriate Strongly Disagree	Length of time waiting at the clinic was appropriate Not Applicable

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Facility was comfortable and clean

Facility was comfortable and clean Strongly Agree

Facility was comfortable and clean Agree

Facility was comfortable and clean Disagree

Facility was comfortable and clean Strongly Disagree

Facility was comfortable and clean Not Applicable

Staff and providers were friendly and helpful

Staff and providers were friendly and helpful Strongly Agree

Staff and providers were friendly and helpful Agree

Staff and providers were friendly and helpful Disagree

Staff and providers were friendly and helpful Strongly Disagree

Staff and providers were friendly and helpful Not Applicable

Health Center hours work for me

Health Center hours work for me Strongly Agree

Health Center hours work for me Agree

Health Center hours work for me Disagree

Health Center hours work for me Strongly Disagree

Health Center hours work for me Not Applicable

Phone calls get through easily

Phone calls get through easily Strongly Agree

Phone calls get through easily Agree

Phone calls get through easily Disagree

Phone calls get through easily Strongly Disagree

Phone calls get through easily Not Applicable

Length of time waiting at the clinic was appropriate

Length of time waiting at the clinic was appropriate Strongly Agree

Length of time waiting at the clinic was appropriate Agree

Length of time waiting at the clinic was appropriate Disagree

Length of time waiting at the clinic was appropriate Strongly Disagree

Length of time waiting at the clinic was appropriate Not Applicable

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
Staff/provider listened to you and spent enough time with you	Staff/provider listened to you and spent enough time with you Strongly Agree	Staff/provider listened to you and spent enough time with you Agree	Staff/provider listened to you and spent enough time with you Disagree	Staff/provider listened to you and spent enough time with you Strongly Disagree	Staff/provider listened to you and spent enough time with you Not Applicable
Staff/provider gives you good advice and treatment	Staff/provider gives you good advice and treatment Strongly Agree	Staff/provider gives you good advice and treatment Agree	Staff/provider gives you good advice and treatment Disagree	Staff/provider gives you good advice and treatment Strongly Disagree	Staff/provider gives you good advice and treatment Not Applicable

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Staff/provider listened to you and spent enough time with you

Staff/provider listened to you and spent enough time with you Strongly Agree

Staff/provider listened to you and spent enough time with you Agree

Staff/provider listened to you and spent enough time with you Disagree

Staff/provider listened to you and spent enough time with you Strongly Disagree

Staff/provider listened to you and spent enough time with you Not Applicable

Staff/provider gives you good advice and treatment

Staff/provider gives you good advice and treatment Strongly Agree

Staff/provider gives you good advice and treatment Agree

Staff/provider gives you good advice and treatment Disagree

Staff/provider gives you good advice and treatment Strongly Disagree

Staff/provider gives you good advice and treatment Not Applicable

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
Someone talked with you about your healthcare/wellness goals	Someone talked with you about your healthcare/wellness goals Strongly Agree	Someone talked with you about your healthcare/wellness goals Agree	Someone talked with you about your healthcare/wellness goals Disagree	Someone talked with you about your healthcare/wellness goals Strongly Disagree	Someone talked with you about your healthcare/wellness goals Not Applicable
You received a copy of your after visit summary (medical only)	You received a copy of your after visit summary (medical only) Strongly Agree	You received a copy of your after visit summary (medical only) Agree	You received a copy of your after visit summary (medical only) Disagree	You received a copy of your after visit summary (medical only) Strongly Disagree	You received a copy of your after visit summary (medical only) Not Applicable
You have been informed what a medical home is	You have been informed what a medical home is Strongly Agree	You have been informed what a medical home is Agree	You have been informed what a medical home is Disagree	You have been informed what a medical home is Strongly Disagree	You have been informed what a medical home is Not Applicable
We help you make healthy lifestyle choices	We help you make healthy lifestyle choices Strongly Agree	We help you make healthy lifestyle choices Agree	We help you make healthy lifestyle choices Disagree	We help you make healthy lifestyle choices Strongly Disagree	We help you make healthy lifestyle choices Not Applicable
You would send your friend and family to us	You would send your friend and family to us Strongly Agree	You would send your friend and family to us Agree	You would send your friend and family to us Disagree	You would send your friend and family to us Strongly Disagree	You would send your friend and family to us Not Applicable
You feel like Five Rivers Health Centers is a partner in your healthcare	You feel like Five Rivers Health Centers is a partner in your healthcare Strongly Agree	You feel like Five Rivers Health Centers is a partner in your healthcare Agree	You feel like Five Rivers Health Centers is a partner in your healthcare Disagree	You feel like Five Rivers Health Centers is a partner in your healthcare Strongly Disagree	You feel like Five Rivers Health Centers is a partner in your healthcare Not Applicable
FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule	FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Strongly Agree	FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Agree	FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Disagree	FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Strongly Disagree	FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Not Applicable

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Someone talked with you about your healthcare/wellness goals

Someone talked with you about your healthcare/wellness goals Strongly Agree

Someone talked with you about your healthcare/wellness goals Agree

Someone talked with you about your healthcare/wellness goals Disagree

Someone talked with you about your healthcare/wellness goals Strongly Disagree

Someone talked with you about your healthcare/wellness goals Not Applicable

You received a copy of your after visit summary (medical only)

You received a copy of your after visit summary (medical only) Strongly Agree

You received a copy of your after visit summary (medical only) Agree

You received a copy of your after visit summary (medical only) Disagree

You received a copy of your after visit summary (medical only) Strongly Disagree

You received a copy of your after visit summary (medical only) Not Applicable

You have been informed what a medical home is

You have been informed what a medical home is Strongly Agree

You have been informed what a medical home is Agree

You have been informed what a medical home is Disagree

You have been informed what a medical home is Strongly Disagree

You have been informed what a medical home is Not Applicable

We help you make healthy lifestyle choices

We help you make healthy lifestyle choices Strongly Agree

We help you make healthy lifestyle choices Agree

We help you make healthy lifestyle choices Disagree

We help you make healthy lifestyle choices Strongly Disagree

We help you make healthy lifestyle choices Not Applicable

You would send your friend and family to us

You would send your friend and family to us Strongly Agree

You would send your friend and family to us Agree

You would send your friend and family to us Disagree

You would send your friend and family to us Strongly Disagree

You would send your friend and family to us Not Applicable

You feel like Five Rivers Health Centers is a partner in your healthcare

You feel like Five Rivers Health Centers is a partner in your healthcare Strongly Agree

You feel like Five Rivers Health Centers is a partner in your healthcare Agree

You feel like Five Rivers Health Centers is a partner in your healthcare Disagree

You feel like Five Rivers Health Centers is a partner in your healthcare Strongly Disagree

You feel like Five Rivers Health Centers is a partner in your healthcare Not Applicable

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Strongly Agree

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Agree

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Disagree

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Strongly Disagree

FRHC Pharmacy home delivery services have been convenient and have helped me stay on my medication schedule Not Applicable

Question Title

* 5. Please rate the statement below regarding financial.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
I have cancelled or rescheduled an appointment due to the cost of the visit	I have cancelled or rescheduled an appointment due to the cost of the visit Strongly Agree	I have cancelled or rescheduled an appointment due to the cost of the visit Agree	I have cancelled or rescheduled an appointment due to the cost of the visit Disagree	I have cancelled or rescheduled an appointment due to the cost of the visit Strongly Disagree	I have cancelled or rescheduled an appointment due to the cost of the visit Not Applicable

September 2019 Dental Center Patient Survey

Please tell us how we are doing

Question Title

* 1. Who did you see today? (Check all that apply)

Question Title

* 2. Please rank each statement below regarding ease of getting care

Question Title

* 3. Please rate each statement below regarding knowledge of you (the patient) as a person

Question Title

* 4. Please rate each statement below regarding general questions about your Medical Home.

Question Title

* 5. Please rate the statement below regarding financial.

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* 6. Comments/suggestions - Is there anyone we can thank for providing you with excellent care today?