Customer Satisfaction Survey Question Title * 1. Overall, how satisfied or dissatisfied are you with the patient care you received at Canyonlands Healthcare? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Please tell us about your experience. OK Question Title * 2. Please write an anonymous comment that we could post on our website about your experience with Canyonlands Healthcare. OK Question Title * 3. How long have you been a patient at Canyonlands Healthcare? This is my first visit Less than six months Six months to a year 1 - 2 years 3 or more years OK Question Title * 4. Which of the following services have you received at Canyonlands Healthcare? Select all that apply. Primary Care Family Planning Women's Health Services Vaccines Dental Behavioral Health Substance Abuse Black Lung Diabetes Management Urgent Care Other (please specify) OK Question Title * 5. How would you rate customer service at Canyonlands Healthcare? Excellent Above average Average Below average Poor Please help us with specific feedback about your experience. OK Question Title * 6. Do you feel your community is aware of the services Canyonlands Healthcare provides? Yes No Somewhat How can we improve our reach in your community? OK Question Title * 7. How did you hear about Canyonlands Healthcare? Internet Search Social Media Newspaper Telephone Book Employer Drive-By Radio Referral Other (please specify) OK Question Title * 8. How could we reach out to your community to provide greater awareness of our healthcare services; i.e, social media, posters, newspaper, internet. OK Question Title * 9. Did you know that Canyonlands Healthcare offers financial services, including sliding fees, Kids Care, AHCCCS Enrollment, Vaccines for Children, Prescription Assistance and other financial programs? Yes No How can we provide more info about these services? OK Question Title * 10. Would you like for a patient care representative to contact you about your experience at Canyonlands Healthcare? Name City/Town State/Province ZIP/Postal Code Email Address Phone Number OK DONE