Physical Rehabilitation Services Patient Survey Thank you for completing our survey. Your feedback is anonymous unless otherwise specified and will help us make improvements so we can better serve you. 1. Which clinic did you visit?*Chase Avenue Family Health CenterChula Vista Family Health CenterCity Heights Family Health CenterDiamond Neighborhoods Family Health CenterEl Cajon Family Health CenterHillcrest Family Health CenterLogan Heights Family Health Center2. Which department did you visit?*Chiropractic2. Which department did you visit?*ChiropracticPhysical Therapy2. Which department did you visit?*Physical Therapy2. Which department did you visit?*Chiropractic2. Which department did you visit?*Sports Medicine2. Which department did you visit?*ChiropracticPhysical TherapySports Medicine2. Which department did you visit?*Physical Therapy3. Who did you see?*I don't rememberDavid Sosa, DCAshley N. Uy, DCNot listed3. Who did you see?*I don't rememberRicardo Amaya, PTPeggy B. Chin, DCAndrew L. Concors, PTCassandra Rodriguez, PTDavid Sosa, DCAdrienne L. Steinbach, PTNot listed3. Who did you see?*I don't rememberNirit S. Blocker, PTIan R. Leavitt, PTVan Q. Nguyen, PTCarmen R. Reyes, PTJason P. Van Dyke, PTNot listed3. Who did you see?*I don't rememberLucilia G. Portela, PTLauren R. Ragazzo, DCDavid Sosa, DCAshley N. Uy, DCNot listed3. Who did you see?*I don't rememberDaniel Corman, DONot listed3. Who did you see?*I don't rememberNeelam Agashe, PTChase L. Billotte, PTPeggy B. Chin, DCElena Hapke, PTRichard J. Rojas, DCBryan J. Schmidt, PTDavid Sosa, DCAshley N. Uy, DCJason P. Van Dyke, PTNot listed3. Who did you see?*I don't rememberNirit S. Blocker, PTMadelynn Dahms, PTKathryn E. Dunn, PTErin K. Folger, PTMichele A. Kunde, PTLucilia G. Portela, PTNot listed4. How was your visit?*Very GoodGoodFairPoorVery PoorPlease tell us how we can improve:5. 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 not6. Were our services affordable?*Very AffordableAffordableNeutralUnaffordableVery Unaffordable7. What can we MOST improve?*Access to CareAppointment AvailabilityAffordabilityCleanliness/AppearanceConfidentialityCustomer ServiceEmpathy/CompassionAccess to Clinic LocationWait TimeOtherNothing, I was pleased with the services.Please describe:8. 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 minutes9. Was the clinic hard to find?*YesNoDid you have difficulty finding parking?*YesNo10. Will you come back again?*YesI don't knowNoPlease tell us why you will not return:11. Would you recommend us to friends and family?*YesI don't knowNoPlease tell us how we can improve:During your most recent visit:12. How friendly was the staff?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:13. How friendly was the nurse?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:14. How friendly was the provider?*Very FriendlyFriendlyNeutralUnfriendlyVery UnfriendlyPlease tell us how we can improve:15. Did the provider answer all of your questions?*YesI did not have questionsNoPlease tell us how we can improve:16. Did you feel rushed by the provider?*Not RushedNeutralRushedPlease tell us how we can improve:17. Did you feel respected by the provider?*YesNeutralNoPlease tell us how we can improve:18. What is your age?*18 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 and olderPrefer not to answer19. Are you:*MaleFemaleFTMMTFNon-binary/third genderGender non-conformingPrefer to self-describePrefer not to sayPlease describe:Follow-up question: Did the staff respect your needs related to your gender identity?YesNeutralNoPlease tell us how we can improve:20. What is your sexual orientation?*Straight/HeterosexualGayLesbianBisexualPrefer to self-describePrefer not to sayPlease describe:Follow-up question: Did the staff respect your needs related to your sexual orientation?YesNeutralNoPlease tell us how we can improve:21. What is your ethnicity?*White / CaucasianHispanic or LatinoBlack or African AmericanNative American or American IndianAsian / Pacific IslanderOtherPrefer not to answer22. 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 answer23. 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 answer24. 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 review25. Would you like to provide a testimonial in support of FHCSD's services?*YesNoName:* First Last Email:* Phone:*Please provide your testimonial:*25. 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 tell us about your experience:*Please copy your testimonial & paste it on our Yelp page.After submitting this form, you will be redirected to our Yelp page.