Patient Experience Questions

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

Is the appointment you are reviewing today within the last -

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

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

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

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

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

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

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

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

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

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?

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* 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?

Would you recommend this dental center to someone else?

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

How did you hear about the dental center?

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

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

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

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

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

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.

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* 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.

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

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

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