We appreciate you taking the time to complete this survey.  The  survey will take about 5 minutes to complete, is confidential and will be utilized to improve the performance at UCS Healthcare. 

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* 1. What location are you at today?

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* 2. This is a confidential and private place.

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* 3. I am satisfied with the amount of time it took to access services.

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* 4. The care provider was helpful and listened to my concerns.

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* 5. I was treated with respect by all staff.

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* 6. Who sent you here for services

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* 7. I was able to  schedule appointments with my counselor/therapist that work with my schedule.

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* 8. How much time did it take to fill out initial forms before seeing my provider?

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* 9. What type of an assessment did you come in for?

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* 10. After your initial paperwork was complete, how long did you wait in the waiting room for your appointment?

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* 11. The waiting room was comfortable and neat (lighting, furniture, cleanliness).

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* 12. Insurance and billing were clearly explained to me at intake.

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* 13. What type of appointment do you prefer?

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* 14. I feel safe when in or around the building.

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* 15. Optional: Name of care provider

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* 16. Optional: Comments and feedback

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* 17. What is your gender identification?

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* 18. What is your age?

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* 19. Which race/ethnicity best describes you? 

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