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* 1. When visiting the clinic, how often do the staff explain things in a way that you understand?

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* 2. When visiting the clinic, how often do the providers (physicians, dentists, behavior health counselors, etc.) listen carefully to you?

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* 3. When visiting the clinic, do the staff do everything that they can to help you with your health issues (ie., pain management, prescription refills, physicals, complaints, etc.)?

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

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* 5. In general, how would you rate your overall health?

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* 6. What is the highest level of school that you have completed?

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* 7. What is your race? Please choose one or more.

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* 8. What kind of things impact the health of your neighbors and you the most?

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* 9. What is keeping you and your neighbors healthy?

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* 10. What 3-5 things could be done in your community to improve the health of your neighbors and you (ie., new services, technology, tele-health, hours of operation, etc.)?

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