School-Based Health Center
HOW ARE WE DOING?

Dear Parent or Guardian:

How well you think the School-Based Health Center at your child's school is meeting your needs?.
This survey is anonymous. If you would like a response to your concerns, you will need to give us your contact information by sharing your comments directly with Cheryl Fazio, our Clinical Operations Officer, by email at cfazio@NoCoFamilyHealth.org or by writing to her at 238 Arsenal Street, Watertown, NY 13601.
Thank you so much for taking the time to share your thoughts with us.

Please tell is how you think we are doing meeting the following program goals:

Question Title

* 1. Getting Care or Advice

	Great	Good	OK	Fair	Bad	Doesn't Apply
Able to get an appointment for your child when you need one	Able to get an appointment for your child when you need one Great	Able to get an appointment for your child when you need one Good	Able to get an appointment for your child when you need one OK	Able to get an appointment for your child when you need one Fair	Able to get an appointment for your child when you need one Bad	Able to get an appointment for your child when you need one Doesn't Apply
Phone calls get through easily	Phone calls get through easily Great	Phone calls get through easily Good	Phone calls get through easily OK	Phone calls get through easily Fair	Phone calls get through easily Bad	Phone calls get through easily Doesn't Apply
Able to get medical advice when the office is closed	Able to get medical advice when the office is closed Great	Able to get medical advice when the office is closed Good	Able to get medical advice when the office is closed OK	Able to get medical advice when the office is closed Fair	Able to get medical advice when the office is closed Bad	Able to get medical advice when the office is closed Doesn't Apply

Question Title

* 2. Front Desk Staff (the people who answer the phones)

	Great	Good	OK	Fair	Bad	Doesn't Apply
Are friendly and helpful	Are friendly and helpful Great	Are friendly and helpful Good	Are friendly and helpful OK	Are friendly and helpful Fair	Are friendly and helpful Bad	Are friendly and helpful Doesn't Apply

Question Title

* 3. Provider (Nurse Practitioner or Dental Hygienist)

	Great	Good	OK	Fair	Bad	Doesn't apply
Listens to you	Listens to you Great	Listens to you Good	Listens to you OK	Listens to you Fair	Listens to you Bad	Listens to you Doesn't apply
Answers your questions	Answers your questions Great	Answers your questions Good	Answers your questions OK	Answers your questions Fair	Answers your questions Bad	Answers your questions Doesn't apply
Is friendly and helpful	Is friendly and helpful Great	Is friendly and helpful Good	Is friendly and helpful OK	Is friendly and helpful Fair	Is friendly and helpful Bad	Is friendly and helpful Doesn't apply
Involves other doctors, specialists or caregivers when needed	Involves other doctors, specialists or caregivers when needed Great	Involves other doctors, specialists or caregivers when needed Good	Involves other doctors, specialists or caregivers when needed OK	Involves other doctors, specialists or caregivers when needed Fair	Involves other doctors, specialists or caregivers when needed Bad	Involves other doctors, specialists or caregivers when needed Doesn't apply
Gives advice and treatment you understand	Gives advice and treatment you understand Great	Gives advice and treatment you understand Good	Gives advice and treatment you understand OK	Gives advice and treatment you understand Fair	Gives advice and treatment you understand Bad	Gives advice and treatment you understand Doesn't apply
Respects your family or personal beliefs	Respects your family or personal beliefs Great	Respects your family or personal beliefs Good	Respects your family or personal beliefs OK	Respects your family or personal beliefs Fair	Respects your family or personal beliefs Bad	Respects your family or personal beliefs Doesn't apply

Question Title

* 4. Our School-Based Health Center

	Great	Good	OK	Fair	Bad	Doesn't Apply
The School-Based Health Center hours work for my family	The School-Based Health Center hours work for my family Great	The School-Based Health Center hours work for my family Good	The School-Based Health Center hours work for my family OK	The School-Based Health Center hours work for my family Fair	The School-Based Health Center hours work for my family Bad	The School-Based Health Center hours work for my family Doesn't Apply
The School-Based Health Center location is easy to find within the school	The School-Based Health Center location is easy to find within the school Great	The School-Based Health Center location is easy to find within the school Good	The School-Based Health Center location is easy to find within the school OK	The School-Based Health Center location is easy to find within the school Fair	The School-Based Health Center location is easy to find within the school Bad	The School-Based Health Center location is easy to find within the school Doesn't Apply
The School-Based Health Center communicates with me in ways I can understand	The School-Based Health Center communicates with me in ways I can understand Great	The School-Based Health Center communicates with me in ways I can understand Good	The School-Based Health Center communicates with me in ways I can understand OK	The School-Based Health Center communicates with me in ways I can understand Fair	The School-Based Health Center communicates with me in ways I can understand Bad	The School-Based Health Center communicates with me in ways I can understand Doesn't Apply

Question Title

* 5. How long has your child(ren) been our patient?

This was our first visit

Less that 2 years

More than 2 years

Question Title

* 6. Your child's visit

	Yes	No	Doesn't apply to me
Did you get a copy of information from your child's visit sent home to you?	Did you get a copy of information from your child's visit sent home to you? Yes	Did you get a copy of information from your child's visit sent home to you? No	Did you get a copy of information from your child's visit sent home to you? Doesn't apply to me
Do you think you will follow any advice or instructions we gave you?	Do you think you will follow any advice or instructions we gave you? Yes	Do you think you will follow any advice or instructions we gave you? No	Do you think you will follow any advice or instructions we gave you? Doesn't apply to me
Do you have problems getting medicine for your child (transportation or cost)?	Do you have problems getting medicine for your child (transportation or cost)? Yes	Do you have problems getting medicine for your child (transportation or cost)? No	Do you have problems getting medicine for your child (transportation or cost)? Doesn't apply to me

Question Title

* 7. Your Experience

	Yes	No	Doesn't Apply
My child(ren) use school-based HEALTH services	My child(ren) use school-based HEALTH services Yes	My child(ren) use school-based HEALTH services No	My child(ren) use school-based HEALTH services Doesn't Apply
My child(ren) use school-based Behavioral Health COUNSELING services	My child(ren) use school-based Behavioral Health COUNSELING services Yes	My child(ren) use school-based Behavioral Health COUNSELING services No	My child(ren) use school-based Behavioral Health COUNSELING services Doesn't Apply
My child(ren) use school-based DENTAL services	My child(ren) use school-based DENTAL services Yes	My child(ren) use school-based DENTAL services No	My child(ren) use school-based DENTAL services Doesn't Apply
If your child(ren) needs services that we do not provide: Have we helped you find the other services you need?	If your child(ren) needs services that we do not provide: Have we helped you find the other services you need? Yes	If your child(ren) needs services that we do not provide: Have we helped you find the other services you need? No	If your child(ren) needs services that we do not provide: Have we helped you find the other services you need? Doesn't Apply
Would you tell friends or family to use our school-based health center?	Would you tell friends or family to use our school-based health center? Yes	Would you tell friends or family to use our school-based health center? No	Would you tell friends or family to use our school-based health center? Doesn't Apply

Question Title

* 8. About You

	Yes	No
Is your child covered by insurance?	Is your child covered by insurance? Yes	Is your child covered by insurance? No
Does your family have stable housing?	Does your family have stable housing? Yes	Does your family have stable housing? No

School-Based Health Center
HOW ARE WE DOING?

Dear Parent or Guardian:

Question Title

* 1. Getting Care or Advice

Question Title

* 2. Front Desk Staff (the people who answer the phones)

Question Title

* 3. Provider (Nurse Practitioner or Dental Hygienist)

Question Title

* 4. Our School-Based Health Center

Question Title

* 5. How long has your child(ren) been our patient?

Question Title

* 6. Your child's visit

Question Title

* 7. Your Experience

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* 8. About You

Question Title

* 9. What do you think we do well?

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* 10. What do you think we could do better?