Patient Experience Questions

Please complete the survey about your most recent visit to a CHSA health center.  Thank you for your participation.

* 1. Is the appointment you are reviewing today within the last -

* 2. When you called to schedule an appointment to be seen right away, when were you seen?

* 3. How often did this provider explain things in a way that was easy to understand?

* 4. Did anyone in this provider's office talk with you about specific goals for your oral health?

* 5. Did your provider or hygienist involve other providers and/or caregivers in your care when needed?

* 6. How often did your provider or hygienist seem informed and up-to-date about the care you got from the other providers and/or caregivers?

* 7. Would you recommend this dental center to someone else?

* 8. How did you hear about the dental center?

* 9. How was your experience when you called your dental center?  (1 being the worst and 10 being the best)

* 10. Do you consider yourself White, Black or African American, Hispanic or Latino, Asian or some other race-ethnic group?

* 11. Indicate below your Primary Dental Provider (PDP) at your dental center.  If you cannot remember your PDP's name, please list the location where you were seen.

* 12. Any other comments you would like to share about the dental center?