Patient Satisfaction Survey for Dr. David Smith 1. Which service did you access?*OtherCare CoordinationCervical Cancer ScreeningChiropracticChronic Disease ManagementGay Men's HealthHand TherapyHealth EducationHepatitis C Testing/ TreatmentHepatologyHIV Testing/ TreatmentImmunizationsInsurance Enrollment ServicesLab ServicesMental Health ServicesMonitored Hormone TherapyPhysical TherapyPrEPPrimary Care (General Medicine)Routine Sick/ Acute CareSports MedicineSTD Screening/ TreatmentWomen's Health Services and Counseling2. How was your visit?*Very GoodGoodFairPoorVery PoorPlease tell us how we can improve:3. 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 review3a. Did you see/ click on an ad like this or something similar?YesNo4. 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 not5. Were our services affordable?*Very AffordableAffordableNeutralUnaffordableVery Unaffordable6. What can we MOST improve?*Access to CareAppointment AvailabilityAffordabilityCleanliness/AppearanceConfidentialityCustomer ServiceEmpathy/CompassionAccess to Clinic LocationWait TimeOtherNothing, I was pleased with the services.Please describe:7. 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 minutes8. 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:9. 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. Would you like to provide a testimonial in support of FHCSD's services?*YesNoName* First Last Email* Phone*Please tell us about your experience:*21. 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.