This is a brief patient satisfaction survey for persons who received services in any of the New York City clinics. The New York City Department of Health and Mental Hygiene wants to determine how well they are satisfying their patients and where they should make improvements.Your honest feedback is very important.

Please be assured that your individual responses to the survey will be confidential and will only be shared with the New York City Department of Health and Mental Hygiene for the purpose of improving the quality of patient care and not for sales, marketing or fund raising.

The goal of this survey is to improve services for patients.

* 1. Have you received services at the New York City Department of Health and Mental Hygiene's Sexual Health Clinic?

* If yes, which clinic location?

As you go through the survey, please rate your experience at this clinic only during your most recent visit.

* Date of visit to clinic?


* 2. From beginning to end, how long was your overall or total time in the clinic?

* 3. If there was a delay, were you given explanation for the delay?

* 4. Were you satisfied with the hours the clinic was opened?

* 5. During this visit, were you given any medication or medications that you had not taken before?

* 6. Before giving any new medicine, did the doctor or nurse explain what the medicine was for?

* 7. How often were the health care professionals able to address your fears or concerns?

* 8. Was the clinic staff courteous and listen to you?

* 9. Did you meet with a drug/ alcohol counselor during your clinic visit? If yes, proceed to the following questions. If no, skip to question 12.

Using any number from 0 to 10, where 0 is the least comfortable and 10 is the most comfortable, what number would you use to rate how comfortable you felt discussing drug/ alcohol use with a counselor at the Sexual Health Clinic?

  Least Comfortable 0 1 2 3 4 5 6 7 8 9 Most Comfortable 10
Discussion with drug/ alcohol counselor

* 10. Did you expect to talk about alcohol, drug or mental health concerns while at the clinic?

* 11. Did the drug/ alcohol counselor give you useful information about the recommended guidelines for drug/ alcohol use?

* 12. Using any number from 0 to 10, where 0 is the worst possible care and 10 is the best possible care, what number would you use to rate each of the health care professionals who cared for you throughout your clinic visit?

  0 (Worst Possible) 1 2 3 4 5 6 7 8 9 10 (Best Possible) Don't Know Does Not Apply
Triage/Reception Staff
Registration Staff
Phlebotomy/Blood-work Staff
Counseling Staff
Clinic Manager
Social Worker
Patient Navigator 
Your overall visit

* 13. Did you find your environment safe, along with your privacy and confidentiality respected during your visit?

For example:
The door was closed so you can have some privacy.

* 14. If you received language assistance services from the clinic, were you satisfied?

* 15. Did you find the following area(s) clean?

  Yes No Don't Know Does Not Apply
Waiting area(s)?
Examination room(s)?

* 16. Would you recommend this clinic to your friends and family?

* 17. Thinking of this visit, what did you like BEST about our clinic?

* 18. Thinking of this visit, what did you like LEAST about our clinic?

* 19. Thinking of this visit, what could the clinic have done better?

* 20. What is your gender?

* 21. How old are you?

* 22. Which of the following do you consider your ethnicity? (optional)

These questions are being asked to make sure we are hearing from a variety of patients. Please remember this survey should only be filled out with information about you, the person who received services at our clinic.

Thank you very much for your time and for your help to help us serve you better!
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