Teens PACT Peers

Patient Perception of Care Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs and expectations. We sincerely appreciate you coming to our health center. Thank you for your time in completing this survey.

 


Please tell us the name of the health center where you receive your care.

Bronx Health Center
CABS Health Center
Caribbean House Health Center
Community League Health Center
Downtown Health Center
Dr. Betty Shabazz Health Center
Helen B. Atkinson Health Center
Long Island City Health Center
Queens Health Center
Mobile Unit

Please Select One:

New Patient
Seen at Center before

Are you:

Male
Female
Transgender

What is your age?

 

50 characters left.

What was your perception with your recent experience in this center?

 Great Good Fair Poor N/A 
Appointment availability
Hours center is open
Success in getting through to the center by phone

What was your perception with how long you had to wait?

 Great Good Fair Poor N/A 
Time in waiting area
Time in exam Room
Waiting for lab work to be performed

What was your perception with the service given by the nurse, medical assistant and lab tech?

 Great Good Fair Poor N/A 
Courteous and helpful to you
Listens to you and answered your questions

What was your perception with the service provided by the physician, dentist, or physician assistant?

 Great Good Fair Poor N/A 
Listens to you and answered your questions
Sensitive to your specific needs and expectations
Explanation of your illness, treatment plan, follow-up instructions
Gives you good advice

What was your perception with the service given to you by the front desk staff?

 Great Good Fair Poor N/A 
Courteous and helpful to you
Answered your questions

What was your perception of the health center?

 Great Good Fair Poor N/A 
Neatness and cleanliness
How well did the health center meet your needs and expectations

What was your perception of the degree of confidentiality practiced?

 Great Good Fair Poor N/A 
Your personal information was kept private
Your visit was provided with confidential/private areas when staff was addressing your needs

Were your concerns about pain management addressed?

Yes
No

Would you refer your friends/relatives to this center?

Yes
No

Do you consider this center your regular source of care?

Yes
No

Did you feel safe and comfortable during your visit?

If no, please comment on how the health center can improve patient safety.

Yes
No
  • Comment:

  • 500 characters left.

What do you like best about our center?

 

350 characters left.

Suggestion for improvement?

 

350 characters left.

THANK YOU FOR COMPLETING OUR SURVEY!