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We’re conducting this survey to learn about your experiences with NEPA Community Health Care (NEPA CHC). This is an opportunity for you to honestly tell us how we are doing and how we might do better. Your responses to this survey will be anonymous.  Nothing you say in this survey will affect your ability to access care at NEPA CHC in any way. Thank you for your feedback!

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* 1. How likely is it that you would recommend NEPA CHC to a friend or family member?

Not at all likely Extremely likely
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i We adjusted the number you entered based on the slider’s scale.

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* 2. What is NEPA CHC good at?

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* 3. What could NEPA CHC do better?

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* 4. Overall, how well has NEPA CHC met your needs?

Not well at all Extremely well
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i We adjusted the number you entered based on the slider’s scale.

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* 5. How often do staff at NEPA CHC treat you with respect?

Never Always
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i We adjusted the number you entered based on the slider’s scale.

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* 6. How long have you been receiving care at NEPA CHC?

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* 7. Overall, how affordable or unaffordable are NEPA CHC services for you?  Please think about the out-of-pocket amount you pay based on our sliding fee scale and/or after insurance coverage (if applicable).

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* 8. How could NEPA CHC help you afford health services? (Check all that apply)

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* 9. How often are you able to get an appointment at NEPA CHC within three (3) business days of when you request it?

Never Always
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i We adjusted the number you entered based on the slider’s scale.

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* 10. NEPA CHC offers a Care Management program for patients.  Typically at no-cost to you, Care Management will assist you in managing your health care needs outside of your scheduled appointments.  What would you like to know? (Check all that apply)

The following optional and confidential questions help us understand who we serve and how we can support you.  Please find the options that are the best fit for you or please self-describe.

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* 11. What is your age?

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* 12. Gender: How do you identify?

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* 13. Race/Ethnicity: How do you identify? (Check all that apply)

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* 14. Language:  What language do you prefer to speak?

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* 15. Which NEPA CHC location do you visit most often?

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