Client Satisfaction Survey

Question Title

* 1. Please select who provided the services you received.

Providers, Doctors, Physician Assistants, Nurse Practitioners, Therapists

Case Manager, Outreach Workers, Enrollment Specialists

Healing Center Staff

Back Offices Staff

Front Desk Staff

Administration

Comments

Question Title

* 2. How would you rate the services you received the last time you received services from us?

	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree
The staff was courteous and attentive to my needs	The staff was courteous and attentive to my needs Strongly Agree	The staff was courteous and attentive to my needs Agree	The staff was courteous and attentive to my needs Somewhat Agree	The staff was courteous and attentive to my needs Disagree	The staff was courteous and attentive to my needs Strongly Disagree
I was involved in decisions about my health and/or medical care	I was involved in decisions about my health and/or medical care Strongly Agree	I was involved in decisions about my health and/or medical care Agree	I was involved in decisions about my health and/or medical care Somewhat Agree	I was involved in decisions about my health and/or medical care Disagree	I was involved in decisions about my health and/or medical care Strongly Disagree
I am pleased with the medical care i received today	I am pleased with the medical care i received today Strongly Agree	I am pleased with the medical care i received today Agree	I am pleased with the medical care i received today Somewhat Agree	I am pleased with the medical care i received today Disagree	I am pleased with the medical care i received today Strongly Disagree
I feel my provider gave me the best medical care he or she could	I feel my provider gave me the best medical care he or she could Strongly Agree	I feel my provider gave me the best medical care he or she could Agree	I feel my provider gave me the best medical care he or she could Somewhat Agree	I feel my provider gave me the best medical care he or she could Disagree	I feel my provider gave me the best medical care he or she could Strongly Disagree
I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family	I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family Strongly Agree	I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family Agree	I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family Somewhat Agree	I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family Disagree	I will recommend Bartz-Altadonna Community Health Center as a place to receive quality medical care to my friends and family Strongly Disagree

Question Title

* 3. What changes would you like to see and how would you implement them?(please do not type your name or personal information in this box)

Question Title

* 4. Other comments you would like to share? (please do not type your name or personal information in this box)