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Personal Health Navigator Satisfaction Survey
1.
How old are you?
Under 18
18-25
26-40
41-55
56+
2.
What is your ethnicity?
Black or African American
Hispanic or Latino
White or Caucasian
Asian or Pacific Islander
Native American or Alaskan Native
Other
Prefer not to answer
3.
I have Medicaid YCCO (Yamhill Community Care) insurance?
Yes
No
4.
I get services with: (Check all that apply)
Yamhill Community Care Organization
Other (please specify)
5.
I am treated with respect and dignity at all times.
Agree
Disagree
Does not apply
6.
How can we make this better?
7.
If I need support, I know I can reach someone.
Agree
Disagree
Does not apply
8.
How can we make this better?
9.
My calls are returned within 24 hours.
Agree
Disagree
Does not apply
10.
How can we make this better?
11.
The staff and peers here believe I can recover, can grow, change, and succeed.
Agree
Disagree
Does not apply
12.
How can we make this better?
13.
The services I receive align with what I want.
Agree
Disagree
Does not apply
14.
How can we make this better?
15.
I receive support in a safe place where I can openly share feedback, suggestions, or concerns.
Agree
Disagree
Does not apply
16.
How can we make this better?
17.
My culture, values, beliefs, traditions and/or lifestyle are respected here and considered as part of whole health and what matters to your complete well-being.
Agree
Disagree
Does not apply
18.
How can we make this better?
19.
I know who to talk to- or what to do- if I have a complaint.
Agree
Disagree
Does not apply
20.
How can we make this better?
21.
I am given resources that align with my health journey including self-help resources such as groups and classes for myself and family members.
Agree
Disagree
Does not apply
22.
How can we make this better?
23.
How long have you been receiving services from a Personal Health Navigator?
Less than 1 month
Between 1-6 months
Between 6-12 months
More than 1 year
Don't know/ Not sure
24.
Do you feel that your Personal Health Navigator treats you fairly?
Yes
No
25.
If you answered disagree to questions 15 or 17: Please explain how you felt unsafe or unfair treatment related t o your whole health/ complete well-being.
26.
How can Personal Health Navigator services be improved?
27.
What have you found most helpful in your experience with Personal Health Navigator services?
28.
What have you found least helpful in your experience with Personal Health Navigator services?
29.
If you require accommodations or language services, were your needs met?
30.
What else would you like to share?