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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!

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* 1. Are you a new or established patient?

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

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* 3. Overall, how would you rate your last visit to the center?

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* 4. Was this visit for a condition that needed care right away or for a check-up or routine care?

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* 5. Did you have an appointment for this last visit?

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* 6. Did you make the appointment for this visit by phone or in person?

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* 7. When you called, how long did it take to reach a person who could schedule your appointment?

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* 8. How would you rate the courtesy and helpfulness of the person you spoke with?

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* 9. How many days passed from when you asked for an appointment until the actual appointment date?

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* 10. How would you rate your satisfaction with this wait for an appointment?

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* 11. Do you have a provider that you see (or will see) regularly at this center?

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* 12. If yes, did you see this provider during your last visit?

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* 13. Identify the Provider you saw at your last visit.

  Medical Providers Primary Care Neuropsychiatry Dental Providers Specialists
Use the drop down boxes to select your provider.

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* 14. In the past 3 months, did you phone the center with a medical (or dental) question during regular office hours? (refills excluded)

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* 15. If yes, did you get an answer to your medical (or dental) question that same day?

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* 16. When you arrived for this visit, how would you rate the courtesy and helpfulness of the reception staff?

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* 17. (Appointments only) Did you see your provider within 15 minutes of your appointment time?

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* 18. From the time of arrival, about how long did you wait in total to see the provider?

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* 19. How would you rate your satisfaction with this wait time?

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* 20. How would you rate the courtesy and helpfulness of the medical/dental staff who assisted the provider?

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* 21. How would you rate the extent to which the provider listened carefully to you

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* 22. How would you rate the extent to which the provider explained things in a way that was easy to understand.

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* 23. How would you rate the extent to wich the provider seemed to know important information about your medical/dental history

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* 24. (Medical Only) Did the provider or a member of the clinical team seem to pay attention to your emotional health?

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* 25. Did the provider or member of the clinical team support you in taking care of your own health?

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* 26. Overal provider rating: On a scale from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?

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* 27. After hours care: In the past three months, have you received any information from the center about what to do if you need care during evenings, weekends, or holidays?

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* 28. Testing: In the past three months, have you had any blood tests, x-rays, or other tests ordered while at the Health Center?

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* 29. Did someone from the center follow up to give you those test results as quickly as needed?

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* 30. Loyality: What is the likelihood that you will return again to the center for care if the need arises?

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* 31. Referral intentions: What is the likelihood that you will refer friends or family members to the center?

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* 32. Positives: Please tell me what you liked the most (best part) about your last visit to the center?

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* 33. Opportunities: Was there anything (else) about this last visit that could be improved in the future?

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