Patient Satisfaction Survey

As a patient of MayView Community Health Center, we value your feedback and opinions. Because we’re always working to improve your experiences at MayView, we’d like to ask you a few questions about our services. 

Please take a few minutes to answer the questions below.  Your responses will be kept confidential. You can also take this survey on paper at any MayView clinic.

To thank you for your participation, we will be holding a quarterly raffle for a $50 gift card. To enter this raffle, please complete question #27 at the end of the survey, or email your name, email address, telephone number and the date you completed this survey to  

The MayView Team

* 1. In general, I rate my overall health as:

* 2. The quality of medical care and services from MayView is:

* 3. My MayView provider (ie: doctor or nurse) involved me in decisions about my care.

* 4. My MayView provider clearly explained to me the benefits and risks of my treatment options and medications.

* 5. MayView understands and respects my culture and beliefs about my health care.

* 6. I am able to find out from MayView how much I would have to pay for a healthcare service or equipment.
(Skip this question if you did not try to find payment information.)

* 7. When I visit MayView, my health care team (staff and providers) discuss helpful things I could do to prevent illness and improve my health.

* 8. If I need to reach MayView after regular office hours, I get answers to my medical questions when I need them.

* 9. Reaching MayView by phone for my visit was easy.

* 10. My provider listened carefully to what I had to say.

* 11. MayView's written materials and website ( provide helpful information.

* 12.  At your most recent visit, did anyone at MayView give you either one of these palm-sized cards (pictured below)?


* 13. Have you ever experienced an unhealthy relationship or been hurt by a sexual partner?

* 14. The MayView staff (other than my provider) are courteous and helpful.

* 15. I can speak with the MayView staff and providers in my preferred spoken language.

* 16. When I speak a language other than English, the interpreter or bilingual staff is knowledgeable about medical information and terminology.

* 17. I receive printed health information in the language that I can read and understand.

* 18. Overall, communicating with MayView is easy and convenient.

* 19. My age range is:

* 20. My gender identity is:

* 21. My highest grade or level of education that I have completed either in the US or another country is:

* 22. I identify as:
(Check all that apply)

* 23. Who makes my healthcare decisions?

* 24. I need an interpreter to communicate my health needs and to understand the health professionals.

* 25. Other suggestions and comments I'd like to share to help MayView improve:

* 26. Do you have access to a computer or smartphone to access the internet?

* 27. OPTIONAL: Please enter your name and email address.

Thank you for your time and comments to help MayView improve its services.

* 28. Office