Patient Satisfaction Survey for Vincent Feitosa 1. How was your visit?*Very GoodGoodFairPoorVery PoorPlease tell us how we can improve:2. How did you hear about us?*Google, online search or online advertisementFHCSD websiteFacebook, Instagram or TwitterFlier, brochure or other printed materialPresentation or table at community eventTalked with a member of FHCSD's outreach teamOutdoor advertisementReferral by friend or family memberReferral from other organizationLong-time FHCSD patientYelp review2a. Did you see/ click on an ad like this or something similar?YesNo3. Were our services affordable?*Very AffordableAffordableNeutralUnaffordableVery Unaffordable4. When at your appointment, how long did you wait until you were seen by a provider?*Less than 10 minutesMore than 15 minutesMore than 45 minutesMore than 60 minutes5. How did you get to your appointment?*I droveI rode the bus/trolleyI took an Uber/Lyft/cabI walkedA friend/family member dropped me offOtherPlease describe:6. Will you come back again?*YesI don't knowNoPlease tell us why you will not return:7. Would you recommend us to friends and family?*YesI don't knowNoPlease tell us how we can improve:During your most recent visit:8. How friendly was the staff?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:9. How friendly was the nurse?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:10. How friendly was the provider?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:11. Did the provider answer all of your questions?*YesI did not have questionsNoPlease tell us how we can improve:12. Did you feel rushed by the provider?*Not RushedNeutralRushedPlease tell us how we can improve:13. Did you feel respected by the provider?*YesNeutralNoPlease tell us how we can improve:14. What is your age?*18 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 and olderPrefer not to answer15. Are you:*MaleFemaleFTMMTFNon-binary/third genderGender non-conformingPrefer to self-describePrefer not to answerPlease describe:Follow-up question: Did the staff respect your needs related to your gender identity?YesNeutralNoPlease tell us how we can improve:16. What is your sexual orientation?*Straight/HeterosexualGayLesbianBisexualPrefer to self-describePrefer not to answerPlease describe:Follow-up question: Did the staff respect your needs related to your sexual orientation?YesNeutralNoPlease tell us how we can improve:17. What is your ethnicity?*White / CaucasianHispanic or LatinoBlack or African AmericanNative American or American IndianAsian / Pacific IslanderOtherPrefer not to answer18. What is the highest grade or level of school that you have completed?*8th grade or lessSome high school but did not graduate/still in high schoolHigh school graduate/GEDSome college or 2-year college degree4-year college degreeMore than a 4-year college degreePrefer not to answer19. What is your household income?*Less than $25,000$25,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999$100,000 to $149,999$150,000 or morePrefer not to answer20. Would you like to provide a testimonial in support of FHCSD's services?*YesNoName* First Last Email* Phone*Please tell us about your experience:*20. We are sorry to hear that you had a less than excellent experience. Would you like us to contact you to address your concerns?*YesNoName:* First Last Email:* Phone:*Please copy your testimonial & paste it on our Yelp page.After submitting this form, you will be redirected to our Yelp page.