Christian Community Health Center (CCHC) - Customer Satisfaction Survey

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* 1. Which CCHC program do you receive the majority of your supportive services? (please select one)

Housing

Amani House

Footprints

Other (please specify)

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* 2. What is your age range? (please select one)

Less than 18 years

19 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 3. What ethnicity do you identify with? (please select one)

Hispanic, Latino

Non-Hispanic, non-Latino

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* 4. What race do you most identify with? (please select all that apply)

White

Black, African-American

Asian

Native Hawaiian or other Pacific-Islander

American Indian or Alaska Native

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* 5. What gender do you identify with? (please select one)

Male

Female

Transgender

Prefer to self-describe:

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* 6. How long have you been receiving supportive services at CCHC? (please select one)

Less than 6 months

6 months to less than a year

1 year to less than 3 years

3 years to less than 5 years

5 years or more

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* 7. Please tell us how well we are doing in our housing/supportive services programs in the following areas: Access, Coordination of Care/Services, Communication, and Well-Being/Care/Support (please select one rating for each statement/question)

	GREAT	GOOD	OK	FAIR	POOR	N/A
Access: Your phone calls, requests or questions were answered promptly	Access: Your phone calls, requests or questions were answered promptly GREAT	Access: Your phone calls, requests or questions were answered promptly GOOD	Access: Your phone calls, requests or questions were answered promptly OK	Access: Your phone calls, requests or questions were answered promptly FAIR	Access: Your phone calls, requests or questions were answered promptly POOR	Access: Your phone calls, requests or questions were answered promptly N/A
Access: Staff clearly stated program rules, expectations or client rights/responsibilities	Access: Staff clearly stated program rules, expectations or client rights/responsibilities GREAT	Access: Staff clearly stated program rules, expectations or client rights/responsibilities GOOD	Access: Staff clearly stated program rules, expectations or client rights/responsibilities OK	Access: Staff clearly stated program rules, expectations or client rights/responsibilities FAIR	Access: Staff clearly stated program rules, expectations or client rights/responsibilities POOR	Access: Staff clearly stated program rules, expectations or client rights/responsibilities N/A
Coordination of Services: Staff provided referrals in a timely manner	Coordination of Services: Staff provided referrals in a timely manner GREAT	Coordination of Services: Staff provided referrals in a timely manner GOOD	Coordination of Services: Staff provided referrals in a timely manner OK	Coordination of Services: Staff provided referrals in a timely manner FAIR	Coordination of Services: Staff provided referrals in a timely manner POOR	Coordination of Services: Staff provided referrals in a timely manner N/A
Coordination of Services: Staff provided information on other CCHC services	Coordination of Services: Staff provided information on other CCHC services GREAT	Coordination of Services: Staff provided information on other CCHC services GOOD	Coordination of Services: Staff provided information on other CCHC services OK	Coordination of Services: Staff provided information on other CCHC services FAIR	Coordination of Services: Staff provided information on other CCHC services POOR	Coordination of Services: Staff provided information on other CCHC services N/A
Coordination of Services: Staff provided information on other community services, resources or supports	Coordination of Services: Staff provided information on other community services, resources or supports GREAT	Coordination of Services: Staff provided information on other community services, resources or supports GOOD	Coordination of Services: Staff provided information on other community services, resources or supports OK	Coordination of Services: Staff provided information on other community services, resources or supports FAIR	Coordination of Services: Staff provided information on other community services, resources or supports POOR	Coordination of Services: Staff provided information on other community services, resources or supports N/A
Communication: Staff explained things to you in a way you understood	Communication: Staff explained things to you in a way you understood GREAT	Communication: Staff explained things to you in a way you understood GOOD	Communication: Staff explained things to you in a way you understood OK	Communication: Staff explained things to you in a way you understood FAIR	Communication: Staff explained things to you in a way you understood POOR	Communication: Staff explained things to you in a way you understood N/A
Communication: Staff treated you with courtesy and respect	Communication: Staff treated you with courtesy and respect GREAT	Communication: Staff treated you with courtesy and respect GOOD	Communication: Staff treated you with courtesy and respect OK	Communication: Staff treated you with courtesy and respect FAIR	Communication: Staff treated you with courtesy and respect POOR	Communication: Staff treated you with courtesy and respect N/A
Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals GREAT	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals GOOD	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals OK	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals FAIR	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals POOR	Well-Being/Care/Support: Staff talked with and supported you about your service plan or goals N/A
Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC?	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? GREAT	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? GOOD	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? OK	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? FAIR	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? POOR	Well-Being/Care/Support: Overall, how would you rate the housing/supportive services you've received from CCHC? N/A

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* 8. Please answer the following questions regarding supportive services.

	Yes	No
Do the services you receive from CCHC address your immediate needs?	Do the services you receive from CCHC address your immediate needs? Yes	Do the services you receive from CCHC address your immediate needs? No
Do you consider CCHC to be your regular resource for supportive services?	Do you consider CCHC to be your regular resource for supportive services? Yes	Do you consider CCHC to be your regular resource for supportive services? No

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* 9. Comments:

What do you like best about our services?

What suggestions do you have for improving our services?