Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. EXIT SCHC Patient Satisfaction Survey Question Title * 1. Please rate your overall experience today 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied Comments/Details: OK Question Title * 2. Which provider did you see today? Christie Griffin, ANP Dr. Harsha Gowtham I don't know Clinic Nurse Jeanette Nienaber, PA-C Ed Gonzalez, FNP Dr. Becki Schellinger Chrissy Forgione, LCSW Gina Catley, LCSW Andrea Helmer, ANP Sam Johnson, LCSW Other (please specify) OK Question Title * 3. When making your appointment, were you given a chance to see your primary care provider? Yes No N/A I don't have a primary care provider Comments/Details: OK Question Title * 4. How satisfied were you with the appointment time you were able to get? 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied 1 Not satisfied at all 2 3 4 5 6 7 8 9 10 Extremely satisfied Comments/details: OK Question Title * 5. How satisfied were you with the following? 1 Not satisfied at all 2 3 4 5 Extremely satisfied N/A Front desk staff knowledge & friendliness Front desk staff knowledge & friendliness 1 Not satisfied at all Front desk staff knowledge & friendliness 2 Front desk staff knowledge & friendliness 3 Front desk staff knowledge & friendliness 4 Front desk staff knowledge & friendliness 5 Extremely satisfied Front desk staff knowledge & friendliness N/A Nursing staff knowledge & friendliness Nursing staff knowledge & friendliness 1 Not satisfied at all Nursing staff knowledge & friendliness 2 Nursing staff knowledge & friendliness 3 Nursing staff knowledge & friendliness 4 Nursing staff knowledge & friendliness 5 Extremely satisfied Nursing staff knowledge & friendliness N/A Provider knowledge & friendliness Provider knowledge & friendliness 1 Not satisfied at all Provider knowledge & friendliness 2 Provider knowledge & friendliness 3 Provider knowledge & friendliness 4 Provider knowledge & friendliness 5 Extremely satisfied Provider knowledge & friendliness N/A Cleanliness of the clinic Cleanliness of the clinic 1 Not satisfied at all Cleanliness of the clinic 2 Cleanliness of the clinic 3 Cleanliness of the clinic 4 Cleanliness of the clinic 5 Extremely satisfied Cleanliness of the clinic N/A Comments/details: OK Question Title * 6. How would you rate the length of time you spent waiting during today's visit? Too short About the right length Too long Comments/details: OK Question Title * 7. How satisfied were you with the amount of time your provider spent with you addressing your needs? Too short About the right length Too long Comments/details: OK Question Title * 8. Is there anyone on our team you would like to recognize or thank for how they cared for you today? No Yes OK Question Title * 9. Are any of these keeping you from reaching your physical and mental wellness goals? None Cost / too expensive I don't have insurance/enough coverage Transportation Access to nutritious foods Access to clean water and utilities (e.g., electricity, sanitation, heating) Lack of family and/or social support Other (please specify) OK Question Title * 10. Is there anything we could have done to improve your visit today? No Yes OK DONE