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. Have you received services at the New York City Department of Health and Mental Hygiene's Sexual Health Clinic?

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* If yes, 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. If there was a delay, were you given explanation for the delay?

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* 4. Were you satisfied with the hours the clinic was opened?

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

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

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* 7. How often were the health care professionals able to address your fears or concerns?

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* 8. Was the clinic staff courteous and listen to you?

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* 9. Did you meet with a drug/ alcohol counselor during your clinic visit?

If Yes, proceed to the following questions. If No, skip to question 12.

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* 10. Using any number from 0 to 10, where 0 is the least comfortable and 10 is the most comfortable, what number would you use to rate how comfortable you felt discussing drug/ alcohol use with a counselor at the Sexual Health Clinic?

  Least Comfortable 0 1 2 3 4 5 6 7 8 9 Most Comfortable 10
Discussion with drug/ alcohol counselor

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* 11. Based on the information you received from the drug/alcohol counselor, how likely are you to make a change to your current drug and/or alcohol use?

Using any number from 0 to 10, where 0 is least likely and 10 is most likely, what number would you use to rate how likely you are to make a change to your current drug and/or alcohol use?

  Not Likely 0 1 2 3 4 5 6 7 8 9 I will absolutely make a change 10
Likely to make a change

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* 12. During your visit, were you referred to the social worker to talk about a concern such as, depression, anxiety, relationship issues, housing instability, sexual assault, intimate partner violence, etc.?

If Yes, proceed to the following questions. If No, skip to question 15.

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* 13. Do you feel the session meet your needs?

If Yes, skip to question 15. If No, proceed to the following question.

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* 14. As a result of this session will you:

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* 15. Using any number from 0 to 10, where 0 is the worst possible care and 10 is the best possible care, what number would you use to rate each of the health care professionals who cared for you throughout your clinic visit?

  0 (Worst Possible) 1 2 3 4 5 6 7 8 9 10 (Best Possible) Don't Know Does Not Apply
Triage/Reception Staff
Registration Staff
Phlebotomy/Blood-work Staff
Counseling Staff
Clinic Manager
Doctor
Social Worker
Patient Navigator 
Your overall visit

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* 16. Did you find your environment safe, along with your privacy and confidentiality respected during your visit?

For example:
The door was closed so you can have some privacy.

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* 17. Did you need language interpretation services?

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