SurveyMonkey Powered Online Survey

1. Tell us about how you heard about us.

We want to thank you and/or your family member for being a patient at Shasta Community Health Center. Our goal is to provide quality medical and dental services with care and compassion. We would like to know how you feel about the services you recently had with us so we can make sure that we are meeting your needs. Please take the time to complete this survey. All responses will be kept confidential. THANK YOU FOR YOUR FEEDBACK!

Question Title

* 1. Are you a new or established patient?

New

Established

Question Title

* 2. (For new patients only) How did you first hear about Shasta Community Health Center (SCHC)?

Referred by friends

Referred by Family Member

Parent - new child visit

Referred from other SCHC site

Referred by healthcare provider (non SCHC)

Referred by hospital ER

Referred by insurance

Referred by government entity/agency

Referred by school

Referred by WIC

Saw while passing by

Community Event/Health Fair

Internet or Social Media

Television or Radio

Newspaper or publication

Do not remember

Page1 / 15