Robeson County Health Department Client Satisfaction Survey
1.
Reason for Visit:
Adult Primary Care
Child Health
Family Planning
Infectious Disease
Immunizations
Maternity
Nurse Family Partnership (NFP)
STD
TB
Other (please specify)
2.
Did you have difficulty getting an appointment
Yes
No
3.
If you were requesting an appointment due to having signs and symptoms of illness, did we see you (by appointment) within the next 24 hours?
Yes
No
N/A
4.
Did you understand the information you were given today?
Yes
No
5.
Convenience of the location of the office?
Excellent
Good
Fair
Poor
N/A
6.
Length of time waiting at office?
Excellent
Good
Fair
Poor
N/A
7.
Time spent with person/people you saw?
Excellent
Good
Fair
Poor
N/A
8.
Explanation of what was done for you?
Excellent
Good
Fair
Poor
N/A
9.
The technical skills (thoroughness,carefulness, competence) of the person you saw?
Excellent
Good
Fair
Poor
N/A
10.
The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw?
Excellent
Good
Fair
Poor
N/A
11.
Office hours suitable to your needs?
Excellent
Good
Fair
Poor
N/A
12.
Comments:
Current Progress,
0 of 12 answered