Cherokee County Health Department Customer Satisfaction Survey Customer Satisfaction Survey Please take a moment to complete our survey to help us better serve you..*All answers are confidential and anonymous* Question Title * 1. What is your age? (Required.) Question Title * 2. What is your gender? (Required.) Male Female Question Title * 3. What is your race? Mark one or more. (Required.) White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Question Title * 4. What county do you live in? (Required.) Cherokee Clay Macon Fannin/ Union Other (please specify) Question Title * 5. Do you currently have health insurance, or not? (Required.) No, I do not Yes, I do (Please specify your provider) Question Title * 6. Why did you choose this clinic? (Required.) Cost Location Privacy Hours Referral Other (please specify) Question Title * 7. Do you find that our current hours 7am-12pm & 1-5pm, Monday- Friday convenient for you? (Required.) Yes, I do No, I do not. (Please tell us what hours work for you.) Question Title * 8. What type of services did you recieve today? Lab Work Sick Visit Physical Immunizations Other (please specify) Question Title * 9. How would you rate your experience at Cherokee County Health Department? (Required.) Poor Fair OK Good Great Scheduling and Sign-In Scheduling and Sign-In Poor Scheduling and Sign-In Fair Scheduling and Sign-In OK Scheduling and Sign-In Good Scheduling and Sign-In Great Wait Time Wait Time Poor Wait Time Fair Wait Time OK Wait Time Good Wait Time Great Nurse, Practitioner, Lab Tech or Case Manager Nurse, Practitioner, Lab Tech or Case Manager Poor Nurse, Practitioner, Lab Tech or Case Manager Fair Nurse, Practitioner, Lab Tech or Case Manager OK Nurse, Practitioner, Lab Tech or Case Manager Good Nurse, Practitioner, Lab Tech or Case Manager Great Price of Services Price of Services Poor Price of Services Fair Price of Services OK Price of Services Good Price of Services Great Facility Facility Poor Facility Fair Facility OK Facility Good Facility Great Likelihood of referring your friends and relatives to us: Likelihood of referring your friends and relatives to us: Poor Likelihood of referring your friends and relatives to us: Fair Likelihood of referring your friends and relatives to us: OK Likelihood of referring your friends and relatives to us: Good Likelihood of referring your friends and relatives to us: Great Let us know how we can improve... Question Title * 10. How did you hear about us? Billboard Friends/Family Radio Newspaper Doctor Website/Facebook Done