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.

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

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

* 3. What is your gender?

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

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

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

* 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). 

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

* 9. How clean is our health center?

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

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

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

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

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

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

* 16. Was our health center staff helpful?

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

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