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Customer Satisfaction Survey
1.
Overall, how satisfied or dissatisfied are you with the patient care you received at Canyonlands Healthcare?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Please tell us about your experience.
2.
Please write an anonymous comment that we could post on our website about your experience with Canyonlands Healthcare.
3.
How long have you been a patient at Canyonlands Healthcare?
This is my first visit
Less than six months
Six months to a year
1 - 2 years
3 or more years
4.
Which of the following services have you received at Canyonlands Healthcare? Select all that apply.
Primary Care
Family Planning
Women's Health Services
Vaccines
Dental
Behavioral Health
Substance Abuse
Black Lung
Diabetes Management
Urgent Care
Other (please specify)
5.
How would you rate customer service at Canyonlands Healthcare?
Excellent
Above average
Average
Below average
Poor
Please help us with specific feedback about your experience.
6.
Do you feel your community is aware of the services Canyonlands Healthcare provides?
Yes
No
Somewhat
How can we improve our reach in your community?
7.
How did you hear about Canyonlands Healthcare?
Internet Search
Social Media
Newspaper
Telephone Book
Employer
Drive-By
Radio
Referral
Other (please specify)
8.
How could we reach out to your community to provide greater awareness of our healthcare services; i.e, social media, posters, newspaper, internet.
9.
Did you know that Canyonlands Healthcare offers financial services, including sliding fees, Kids Care, AHCCCS Enrollment, Vaccines for Children, Prescription Assistance and other financial programs?
Yes
No
How can we provide more info about these services?
10.
Would you like for a patient care representative to contact you about your experience at Canyonlands Healthcare?
Name
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
Current Progress,
0 of 10 answered