Positive Impact Health Centers (PIHC) believes in patient-centered care that is both respectful and responsive to individual patient needs, and one way we can make sure we’re providing quality care is by hearing from you. Please take a moment to complete this questionnaire to let us know how we’re doing.

This is an anonymous survey, so none of the feedback you give will be connected or identifiable to you. Please know that you are not required to complete this survey and none of your services will be affected if you decline to complete it.

By completing this survey, you agree to let us use your provided feedback to enhance our services.

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* 1. Please think about the services you get from us and rate how much you agree with the below statements.If you receive more than one services, please think about your overall experience as a client at PIHC:

  Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
I feel welcome at PIHC
I feel safe at PIHC
Front desk staff treat me with respect
I feel like I get helpful answers to the questions that I ask
I feel like a member of my care team
I feel like PIHC staff care about my health and wellbeing
I was able to reach somebody who could help me when I called
*For patients who access more than one service at PIHC*
I feel like I receive coordinated care

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* 2. PIHC staff is sensitive to: (please select all that apply)

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* 3. If there is one thing PIHC can do to improve our services, what would it be?

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* 4. Would you recommend PIHC to others?

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* 5. Do you experience any barriers that prevent you from getting the care you
need at PIHC?

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* 6. If yes, please select which category best fits your barrier (please select all
that apply):

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* 7. Which service(s) do you access at PIHC? (please select all that apply)

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* 8. Please rate the following statements about the cleanliness and comfort of
the PIHC building using the table below:

  Excellent Good Fair Poor
The comfort of the PIHC lobby
The cleanliness of the PIHC lobby
The ease of finding the office (signage, directions, etc.)
The privacy of the counseling and/or exam rooms
Please tell us a little about yourself.

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* 9. Which age group describes you?

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* 10. What race do you identify as? (please select all that apply)

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* 11. Are you of Hispanic or Latino origin?

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* 12. What gender do you identify as?

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* 13. Which of the following terms best describes your sexual orientation?

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* 14. How long have you accessed services at PIHC (please include your time
before the merger at either Positive Impact or AID Gwinnet)?

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* 15. If you are HIV positive, how long since your diagnosis?

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