This is a brief patient satisfaction survey for persons who received services in any of the New York City clinics. The New York City Department of Health and Mental Hygiene wants to determine how well they are satisfying their patients and where they should make improvements.Your honest feedback is very important.

Please be assured that your individual responses to the survey will be confidential and will only be shared with the New York City Department of Health and Mental Hygiene for the purpose of improving the quality of patient care and not for sales, marketing or fund raising.

The goal of this survey is to improve services for patients.

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* 1. If you received services at the New York City Department of Health and Mental Hygiene's Sexual Health Clinic, which clinic location?

As you go through the survey, please rate your experience at this clinic only during your most recent visit.

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* Date of most recent visit to clinic?

Date

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* 2. From beginning to end, how long was your overall or total time in the clinic?

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* 3. During this visit, were you given any medication or medications that you had not taken before?

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* 4. Before giving any new medicine, did the doctor or nurse explain what the medicine was for?

Using any number from 1 to 5, where 1 is the worst possible option and 5 is the best possible option, what number would you use to rate each of the clinical service throughout your clinic visit?

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* 5. How would you rate the health care professionals' ability to address your fears or concerns?

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* 6. How would you rate the health care professionals' ability to respect your privacy/confidentiality?

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* 7. Services provided by clinic personnel

  1 2 3 4 5 N/A
Triage/Reception Staff
Registration Staff
Phlebotomy/Blood-work Staff
Counseling Staff
Doctor
Social Worker
Patient Navigator 

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* 8. Were signage and directions easy to follow at the clinic?

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* 9. Did you need language interpretation services?

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* 10. Did you receive language interpretation services from the health department?

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* 11. Were you satisfied with the language interpretation services you received?

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* 12. Did you find the following area(s) clean?

  Yes No Does Not Apply
Waiting area(s)?
Examination room(s)?
Bathroom(s)?

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* 13. Would you recommend this clinic to your friends and family?

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* 14. Thinking of this visit, what could the clinic have done better?

Tell us about yourself (optional)

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* 15. How would you describe your gender?

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* 16. Which of the following do you consider your ethnicity? (check all that apply)

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* 17. How old are you?

These questions are being asked to make sure we are hearing from a variety of patients. Please remember this survey should only be filled out with information about you, the person who received services at our clinic.

Thank you very much for your time and for your help to help us serve you better!

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