You can help us make our care and service better by filling out this survey. Circle the answer that best describes your experience or a family member’s experience during a visit to our health center. You can offer comments or ideas in the blank space below. After you finish the survey, you can drop it in the box.

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* 1. Is this your first visit to our health center?

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* 2. What is the age group of the person being seen today?

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* 3. What is your gender?

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* 4. How easy was it to schedule your appointment?

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* 5. How helpful was the person who scheduled your appointment?

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* 6. Could you benefit from the WZZHC having extended hours?

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* 7. If you answered Yes to benefiting from the WZZHC having extended hours, please tell us which time-frames would work best for you? (You can chose one or both answers). 

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* 8. How clean are the restrooms in our health center? 

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* 9. How clean is our health center?

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* 10. How much respect do we show for your privacy? 

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* 11. How quick was your check-in at the registration window? 

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* 12. Was the staff in the department(s) you visited friendly? 

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* 13. Did your provider clearly give details of your sickness or health condition in a way you could understand?

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* 14. Would you suggest this PROVIDER to your friends and family?

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* 15. Did the Pharmacy give you information about your medications?

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* 16. Was our health center staff helpful?

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* 17. Would you suggest this Health Center to your friends and family?

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* 18. Please share any other comments, ideas or suggestions: 

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