1. Patient Satisfaction Surveys JCHCC

 
100% of survey complete.

Jefferson community Health Centers Inc. is committed to providing the best services possible to our patients. We ask you assistance in evaluating our services by completing this short survey.

Date Survey Submitted?

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* 1. Date Survey Submitted?

Location of JCHCC for this visit

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* 2. Location of JCHCC for this visit

Reason for Today's Visit

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* 3. Reason for Today's Visit

Gender

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* 4. Gender

Are you :

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* 5. Are you :

Race/Ethnicity

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* 6. Race/Ethnicity

Type of Health Insurance

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* 7. Type of Health Insurance

Do you have any suggestions that may help us to improve our services?

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* 9. Do you have any suggestions that may help us to improve our services?

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