Provider Patient Satisfaction Survey 1. Which clinic did you visit?*Please select oneBeach Area Family Health CenterBeach Area Women's Health CenterChase Avenue Family Health CenterChula Vista Family Health CenterCity Heights Family Health CenterDiamond Neighborhoods Family Health CenterDowntown Family Health Center at ConnectionsEl Cajon Family Health CenterElm Street Family Health CenterFamilyHealth at City CollegeFamilyHealth at College GroveFamilyHealth on CommercialGrossmont Spring Valley Family Health CenterHillcrest Family Health CenterHillcrest Family Health Center on Third AvenueIbarra Family Health CenterLemon Grove Family Health CenterLogan Heights - Adobe Building (PCSS)Logan Heights Family Health CenterLogan Heights Family Health Center - Urgent CareMobile Medical UnitsNational City Family Health CenterNorth Park Family Health CenterNorth Park Pediatric Clinic & Women's Health CenterOak Park Family Health CenterRice Family Health CenterSherman Heights Family Health CenterI don't remember1a. Did you find the information on the lobby televisions screens useful?YesI don't knowNo2. How was your visit?*Very GoodGoodFairPoorVery PoorPlease tell us how we can improve:3. Did you have an appointment?*YesNoHow long did you wait for an appointment?*Same day1 day2 to 3 days4 to 7 daysMore than 7 daysDid you get an appointment reminder?*Phone callText messageNo, I did not4. Were our services affordable?*Very AffordableAffordableNeutralUnaffordableVery Unaffordable5. What can we MOST improve?*Access to CareAppointment AvailabilityAffordabilityCleanliness/AppearanceConfidentialityCustomer ServiceEmpathy/CompassionAccess to Clinic LocationWait TimeOtherNothing, I was pleased with the services.Please describe:6. 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 minutes7. Did you feel safe inside the clinic?*Very SafeSafeNeutralUnsafeVery UnsafePlease tell us how we can improve:8. How did you get to your appointment?*I droveI rode the bus/trolleyI took an Uber/Lyft/cabI walkedA friend/family member dropped me offOther9. Will you come back again?*YesI don't knowNoPlease tell us why you will not return:10. Would you recommend us to friends and family?*YesI don't knowNoPlease tell us how we can improve:During your most recent visit:11. How friendly was the staff?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:12. How friendly was the nurse?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:13. How friendly was the provider?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:14. Did the provider answer all of your questions?*YesI did not have questionsNoPlease tell us how we can improve:15. Did you feel rushed by the provider?*Not RushedNeutralRushedPlease tell us how we can improve:16. Did you feel respected by the provider?*YesNeutralNoPlease tell us how we can improve:17. What is your age?*18 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 and olderPrefer not to answer18. 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:19. 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:20. What is your ethnicity?*White / CaucasianHispanic or LatinoBlack or African AmericanNative American or American IndianAsian / Pacific IslanderOtherPrefer not to answer21. 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 answer22. 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 answer23. How did you hear about us?*Online searchFHCSD websiteSocial MediaFlier, 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 review24. Would you like to provide a testimonial in support of FHCSD's services?*YesNoName* First Last Email* Phone*Please tell us about your experience:*24. 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 Name 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.