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.

Is this your first visit to our health center?

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

What is the age group of the person being seen today?

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

What is your gender?

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* 3. What is your gender?

How easy was it to schedule your appointment?

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

How helpful was the person who scheduled your appointment?

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

Could you benefit from the WZZHC having extended hours?

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

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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* 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). 

How clean are the restrooms in our health center? 

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

How clean is our health center?

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* 9. How clean is our health center?

How much respect do we show for your privacy? 

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

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

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

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

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

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

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

Would you suggest this PROVIDER to your friends and family?

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

Did the Pharmacy give you information about your medications?

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

Was our health center staff helpful?

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* 16. Was our health center staff helpful?

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

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

Please share any other comments, ideas or suggestions: 

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

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