Survey 2014 4 E Question Title * 1. Date of Visit? Date Date Question Title * 2. Is this your first visit? No Yes Question Title * 3. What was the reason for your visit? Immunizations Sick Visit Family Planning Lab Test Physical Exam Eligibility Other (please specify) Question Title * 4. Was it easy to get an appointment for the date and time you wanted? Yes No I did not have an appointment Question Title * 5. How many minutes did you wait before seeing the provider? Less than 15 minutes 15 -30 minutes 31-60 minutes More than one hour Question Title * 6. How many minutes total were you at the clinic? Less than 30 minutes 30-60 minutes 1-2 hours More than 2 hours Question Title * 7. Helpfulness of staff Excellent Good Average Poor Not applicable Question Title * 8. Cost of Services? Excellent Good Average Poor Not applicable Question Title * 9. Condition of waiting area? Excellent Good Average Poor Not applicable Question Title * 10. How was your wait time? Excellent Good Average Poor Not applicable Question Title * 11. Was your privacy maintained? Excellent Good Average Poor Not applicable Question Title * 12. Did the nurses and provider talked to you in a way that was easy to understand? Yes No Question Title * 13. Your questions and concerns were addressed to your satisfaction? Yes No Question Title * 14. Rate your overall experience at the clinic? Excellent Good Average Poor Not applicable Question Title * 15. Would you recommend this clinic to a friend or family member? Yes No Please write any additional comments you have about this clinic: Question Title * 16. Thank you for your time. We appreciate your opinion. Thank you for choosing Andrews County Health Department. Done