Upon each visit, we would like to know how you feel about the services we provide so we can make sure your needs are met. Your responses are directly responsible for our performance improvement, and will be confidential and anonymous (unless you request to be contacted).  Thank you for your time and assistance.  Your opinion matters!

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* 1. Your Age Range:

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* 2. Your Gender:

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* 3. Your Primary Language:

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* 4. Access Carroll is Your Health Care Home (Primary Source of Care) for:

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* 5. Services You've Received at Access Carroll:

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* 6. Please Rate The Services You Received at Access Carroll

  Great Good OK Fair Poor N/A
Ease and convenience of scheduling an appointment
Office hours
Courtesy and friendliness of the office staff
Quality of care given by your Health Care Provider(s)
Cleanliness and tidiness of the facility
Privacy and Confidentiality

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* 7. Please Rate Your Basic Access to Care

  Always Usually Sometimes Never N/A
Access Carroll helped reduce my need to go to the local Emergency Department
Access Carroll has helped me be more consistent with my medications, check ups and overall health care
Access Carroll has helped me obtain health care services that I could not have obtained on my own
I Have Transportation Needs/Problems
I Can Find Parking Availability

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* 8. What suggestions, if any, do you have on improving services at Access Carroll?

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* 9. Additional comments.

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* 10. Would you like to be contacted regarding your most recent visit?

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* 11. Please provide us your contact information, if applicable.  Note: providing your name will result in your survey no longer being anonymous.

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