Improving Referrals to Community Health Workers

Thank you for taking a moment to complete this brief survey. We're hoping to better understand how we can improve the referral process to our Community Health Worker (CHW) Program. Your feedback will help us identify barriers, clarify the program’s value, and strengthen how we support both you and your patients. This should only take a few minutes, and your input is greatly appreciated.

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* 1. What is your name?

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* 2. How familiar are you with the services provided by our Community Health Workers?

Very familiar

Somewhat familiar

Not at all familiar

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* 3. What barriers do you face when making referrals to Community Health Workers? Select all that apply.

Lack of awareness

Time constraints

Complex referral process

Unsure of benefits

Other (please specify)

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* 4. Please describe any other reasons that might prevent you from making referrals to Community Health Workers.

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* 5. How effective do you think Community Health Workers are in supporting patient care?

Very effective

Somewhat effective

Not at all effective

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* 6. What would encourage you to make more referrals to Community Health Workers? Select all that apply.

Simplified referral process

Increased awareness of benefits

Success stories

Training sessions

Feedback on referrals

Other (please specify)

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* 7. Do you have any suggestions for improving the referral process to Community Health Workers?

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* 8. How likely are you to recommend the use of Community Health Workers to your colleagues?

Very likely

Somewhat likely

Not likely