Skip to content
JeffCare Satisfaction Survey
Your voice is the most valuable feedback we can receive. Please help us to continuously assess how we are living up to our Mission.
1.
Optional, contact information
First and Last Name
Email Address
Phone Number
2.
Which JeffCare Health Center are you providing feedback for?
JeffCare East Bank Health Center
JeffCare West Bank health Center
3.
Which service(s) did you receive today
Behavioral Health Medication Management
Behavioral Health Individual and/or Group Therapy
Behavioral Health Injection
Primary Care Services
4.
Ease of intake and registration as a new patient, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
5.
Helpfulness of the staff checking me in for my appointment, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
6.
Waiting time to check-in, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
7.
Comfort of the waiting area/lobby, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
8.
Feedback/comments on Administrative Support staff
9.
Helpfulness of nursing staff, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
10.
Trust in the skills of the nursing staff assisting you before seeing the provider, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
11.
Feedback/comment on nursing staff
12.
Satisfaction with your provider’s explanation of treatment/plan, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
13.
Treatment provider(s) provided me with an opportunity to ask questions, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
14.
Satisfaction with your provider(s) concern for your treatment, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
15.
Your trust in the skill of the provider(s) who provided your treatment, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
16.
Feedback/comment on treatment provider staff
17.
Staff members you interacted with treated you with respect and dignity
1 star
2 stars
3 stars
4 stars
5 stars
18.
Overall satisfaction with Covid precautions (staff wearing masks, distancing, signs posted with expectations, etc.)
1 star
2 stars
3 stars
4 stars
5 stars
19.
Responsiveness to any concerns/complaints reported during your visit, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
20.
Overall satisfaction with how well the staff worked together to provide your care
1 star
2 stars
3 stars
4 stars
5 stars
21.
Likeliness of you recommending JeffCare services to others
1 star
2 stars
3 stars
4 stars
5 stars
22.
Overall satisfaction with the average length of time between the day an appointment was requested and the date of the appointment, skip if not applicable
1 star
2 stars
3 stars
4 stars
5 stars
23.
Would you be interested in before-hours appointment times (7-8am)?
Yes
No
24.
Would you be interested in after-hours appointments (5-6 pm)?
Yes
No
1 / 1
100%
