Patient Survey: Your Care at CHN
RequiredRequired Question(s)
Please fill out this survey to let us know how you feel about your care at CHN.
 
Required
Date:

 

 

50 characters left.
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Center:
Helen B. Atkinson - 81 West 115th Street
Community League - 511 West 157th Street
Catherine M. Abate - 150 Essex Street
CABS - 94 Manhattan Avenue #98
Caribbean House - 1167 Nostrand Avenue
Dr. Betty Shabazz - 999 Blake Avenue
Queens Health Center - 97-04 Sutphin Boulevard
Long Island City - 36-11 21st Street
Family Health Center - 90-04 161st Street
Bronx Health Center - 975 Westchester Avenue
Tremont - 4215 Third Avenue
Medical Mobile Van
Seward Park Campus
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Are you a new patient? 

Yes
No
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Age:
 

50 characters left.
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What is your sex?
Male
Female
Transgender Male to Female
Transgender Female to Male
  • Comment:

  • 500 characters left.
Please fill in a circle to show how much you agree with each statement.
 

Making an appointment:

 Strongly Agree Agree Not Sure Disagree Strongly Disagree 
I was able to make an appointment quickly.
The center is open when I need it.
I was able to reach the center by phone.

My doctor or dentist:

 Strongly Agree Agree Not Sure Disagree Strongly Disagree 
My doctor or dentist listened to me.
My doctor or dentist answered my questions.
My doctor or dentist talked to me about my health in a way I could understand.
My health problem was taken care of.
My doctor or dentist spoke to me with respect.
Center staff:
 Strongly Agree Agree Not Sure Disagree Strongly Disagree 
The staff listened to me.
The staff answered my questions.
The staff talked to me about my health in a way I could understand.
The staff spoke to me with respect.
The staff was friendly and helpful.
Our health center:
 Strongly Agree Agree Not Sure Disagree Strongly Disagree 
The health center was neat and clean.
I felt safe and comfortable during my visit.
I felt like my personal information was kept private.
I am happy with the care I get at this center.
If you selected Disagree or Strongly Disagree for any statement, please tell us more:

 

 

350 characters left.

How was your wait time at the center today?

 

350 characters left.
What did you like about your visit today?
 

350 characters left.
How can we make our center better?
 

350 characters left.
Thank you for filling out our survey! Your answers will help us improve our health center.