Exit

Please answer ALL questions

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for you time.

Question Title

* 1. Your Age

Infant to 120
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 2. Your Sex

Question Title

* 3. Your Race/Ethnicity

Question Title

* 4. Name of Provider:

Question Title

* 5. Appointment?

Question Title

* 6. Do you consider this center your regular source of care?

Question Title

* 7. Ease of Getting Care: Ability to get in to be seen

Question Title

* 8. Ease of Getting Care: Hours Center is open

Question Title

* 9. When do you prefer scheduling your appointments?

Question Title

* 10. Ease of Getting Care: Convenience of Center's location

Question Title

* 11. Ease of Getting Care: Prompt return on calls

Question Title

* 12. Waiting: Time in waiting room

Question Title

* 13. Waiting: Time in exam room

Question Title

* 14. Waiting: Waiting for tests to be performed

Question Title

* 15. Waiting: Waiting for tests results

Question Title

* 16. STAFF:  Provider: Physician, Behavioral Health, Dentist, Nurse Practitioner - Listens to you

Question Title

* 17. STAFF:  Provider: Physician, Behavioral Health, Dentist, Nurse Practitioner - Takes enough time with you

Question Title

* 18. STAFF:  Provider: Physician, Behavioral Health, Dentist, Nurse Practitioner  - Explains what you want to know

Question Title

* 19. STAFF:  Provider: Physician, Behavioral Health, Dentist, Nurse Practitioner  - Gives you good advice and treatment

Question Title

* 20. STAFF:  Nurses, Medical Assistants and Dental Assistants - Friendly and helpful to you

Question Title

* 21. STAFF:
Nurses, Medical Assistants and Dental Assistants - Answers your questions

Question Title

* 22. STAFF:  (Health Educator, Case Manager, Outreach-Eligibility, and all others) - Friendly and helpful to you

Question Title

* 23. STAFF:  (Health Educator, Case Manager, Outreach-Eligibility, and all others) - Answers your questions

Question Title

* 24. STAFF:  (Health Educator, Case Manager, Outreach-Eligibility, and all others) - Interpretation/Translation services

Question Title

* 25. Payment: What you pay

Question Title

* 26. Payment: Explanation of charges

Question Title

* 27. Payment: Collection of payment/money

Question Title

* 28. Are you aware of that LCHC has financial assistance (i.e., sliding fee scale, budget plans, etc.)?

Question Title

* 29. Facility: Neat and clean building

Question Title

* 30. Facility: Ease of finding where to go

Question Title

* 31. Facility: Comfort and Safety while waiting

Question Title

* 32. Facility: Privacy

Question Title

* 33. Facility: Appointment days and hours

Question Title

* 34. Confidentiality: Keeping my personal information private

Question Title

* 35. The likelihood of referring your friends and relatives to us

Question Title

* 36. NOTE:  Please provide any SPECIFIC DETAIL for any item rated 3 or below:

Question Title

* 37. What do you like best about our center?

Question Title

* 38. What do you like least about our center?

Question Title

* 39. Do you have any suggestions for improvement?

Question Title

* 40. Provide information ONLY if you would like us to contact you:

Name: ____________________________________________________________________

Email: _____________________________________________________________________

Telephone: _______________________________________________________________

( Privacy & Cookie Notice

T