SurveyMonkey Powered Online Survey

Bonita Community Health Center Patient Satisfaction Survey

Thank you for choosing Bonita Community Health Center. We are conducting a survey, and your response is extremely valuable so that we can evaluate and improve our performance. All responses are anonymous and confidential.

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* 1. Please evaluate the following statements.

	Excellent	Good	Average	Poor	N/A
Courtesy and professionalism of the staff.	Courtesy and professionalism of the staff. Excellent	Courtesy and professionalism of the staff. Good	Courtesy and professionalism of the staff. Average	Courtesy and professionalism of the staff. Poor	Courtesy and professionalism of the staff. N/A
Explanation of your payment responsibilities.	Explanation of your payment responsibilities. Excellent	Explanation of your payment responsibilities. Good	Explanation of your payment responsibilities. Average	Explanation of your payment responsibilities. Poor	Explanation of your payment responsibilities. N/A
Appearance and cleanliness of the facility.	Appearance and cleanliness of the facility. Excellent	Appearance and cleanliness of the facility. Good	Appearance and cleanliness of the facility. Average	Appearance and cleanliness of the facility. Poor	Appearance and cleanliness of the facility. N/A
Waiting time compared with anticipated time.	Waiting time compared with anticipated time. Excellent	Waiting time compared with anticipated time. Good	Waiting time compared with anticipated time. Average	Waiting time compared with anticipated time. Poor	Waiting time compared with anticipated time. N/A
Respect shown for my privacy during my care.	Respect shown for my privacy during my care. Excellent	Respect shown for my privacy during my care. Good	Respect shown for my privacy during my care. Average	Respect shown for my privacy during my care. Poor	Respect shown for my privacy during my care. N/A

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* 2. Please answer YES or NO to the following questions.

	Yes	No
I would return to BCHC if the need arose.	I would return to BCHC if the need arose. Yes	I would return to BCHC if the need arose. No
I would recommend BCHC to my family and friends.	I would recommend BCHC to my family and friends. Yes	I would recommend BCHC to my family and friends. No

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* 3. Service Used

	Urgent Care	Radiology	Surgery	Rehabilitation	Pain
Please select which service you used today.	Please select which service you used today. Urgent Care	Please select which service you used today. Radiology	Please select which service you used today. Surgery	Please select which service you used today. Rehabilitation	Please select which service you used today. Pain

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* 4. How did you hear about us?

Friend/Family

Bonita Banner

Spotlight

D'latino

Google

Dex

Facebook

Yelp

Bing

Radio

Health Fair

Other

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* 1. Please evaluate the following statements.

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* 2. Please answer YES or NO to the following questions.

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* 3. Service Used

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* 4. How did you hear about us?

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* 5. Do you have any other comments, questions, or concerns?