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* 1. Are you currently a patient at Circle Care Center?

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* 2. When was your last appointment?

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* 3. What is your current age?

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* 4. Do you identify with any of the following statements?
(Choose all that apply)

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* 5. Which of our providers have you seen the most in the past 12 months?

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* 6. Have you received sexual health services at Circle Care Center in the past 12 months (STI testing or treatment)? 

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* 7. What do you like most about Circle Care Center as a medical practice?

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* 8. What do you feel can be improved? 

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* 9. Do you feel that CCC is an affirming practice for all people, especially those in the LGBTQ+ community? What makes you feel that way?

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* 10. Please respond to the following statements by ranking how much you agree with them.
5 = strongly agree, 1 = strongly disagree.

  5 - Strongly Agree 4 3 - Neutral 2 1 - Strongly Disagree
The medical services I receive at Circle Care Center are high quality. 
It is easy to schedule appointments at Circle Care Center.
The front desk staff are always precise and efficient in communication. 
My appointments are always on time. 
The medical staff provide excellent care and always answer my questions.
The providers make me feel comfortable and affirmed. 
My billing is always accurate and clearly communicated. 

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* 11. What would be most convenient for you if Circle Care Center added additional hours to its schedule? 

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* 12. Do you use Circle Care Center Pharmacy?

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* 13. If you have used Circle Care Center Pharmacy, how would you rate their services? 
(5 = very satisfied, 1 = not satisfied)

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* 14. Are you aware that a portion of the practice revenue at CCC supports local LGBTQ+ community services and services for people living with HIV?

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* 15. Is that important to you? 

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* 16. Which of the below social media channels do you use regularly?

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* 17. Have you visited our website? www.circlecarecenter.org

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* 18. Do you use our patient portal?

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* 19. How did you first discover/hear about Circle Care Center?

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* 20. What local community events do you attend?

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* 21. Would you refer CCC to a friend or family member?

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* 22. If you answered "no" to the question above, please tell us why? 

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* 23. Is there any additional feedback you want to share with Circle Care Center? 

0 of 23 answered
 

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