We're conducting this survey to learn about your experience with NEPA Community Health Care (NEPA CHC). This is an opportunity for you to honestly tell us how we are doing and how we might do better. Your responses to this survey will be anonymous. Nothing you say in this survey will affect your ability to access care at NEPA CHC in any way. Thank you for your feedback!

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* 1. How likely is it that you would recommend NEPA CHC to a friend or family member?

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* 2. What is NEPA CHC good at?

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* 3. What could NEPA CHC do better? 

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* 4. Overall, how well has NEPA CHC met your needs? 

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* 5. How often do staff at NEPA CHC treat you with respect? 

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* 6. How long have you been receiving care at NEPA CHC?

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* 7. If this is your first visit or you have been receiving care for less than one year at NEPA CHC, how did you hear about our services?

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* 8. Overall, how affordable or unaffordable are NEPA CHC services for you? Please think about the out-of-pocket amount you pay based on our sliding fee scale and/or after insurance coverage (if applicable).

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* 9. How could NEPA CHC help you afford health services? (Check all that apply)

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* 10. How often are you able to get an appointment at NEPA CHC within three (3) business days of when you request it? 

The following optional and confidential questions help us understand who we serve and how we can support you. Please find the options that are the best fit for you or please self-describe. 

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* 11. What is your age? 

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* 12. Gender: How do you identify?

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* 13. Race/Ethnicity: how do you identify? (Check all that apply)

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* 14. Language: What language do you prefer to speak?

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* 15. Which NEPA CHC location do you visit most often?

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