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SCHC Patient Satisfaction Survey

Patient Satisfaction Survey - SCHC

Welcome to the Siletz Community Health Clinic (SCHC)! SCHC is committed to providing you with the best possible services. Your participation in this survey is extremely important and will serve as a tool to improve and enhance the Siletz Community Health Clinic.

1. On a scale from 1 to 10 with 10 being the easiest, how easy was it to schedule an appointment with our facility?(Required)

1

2

3

4

5

6

7

8

9

10

2. How long did you wait (beyond your appointment time) to be seen by the provider?(Required)

Less than 10 minutes

10 - 20 minutes

20 - 30 minutes

More than 30 minutes

3. On a scale from 1 to 10 with 10 being the best, How satisfied are you with the cleanliness and appearance of our facility?(Required)

1

2

3

4

5

6

7

8

9

10

4. How would you rate the overall care you received from your provider, with 10 being the best (doctor, dentist, pharmacist, mental health therapist, etc.)?(Required)

1

2

3

4

5

6

7

8

9

10

5. How would you rate the overall care you received from staff, with 10 being the best?(Required)

1

2

3

4

5

6

7

8

9

10

6. How likely are you to recommend our facility to a friend or family member, with 10 being highly likely?(Required)

1

2

3

4

5

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8

9

10

7. Were your questions answered and did you leave with an understanding of any follow up that needs to happen?(Required)

Yes

No

8. How many years have you been a patient at the Siletz Community Health Clinic?(Required)

Less than one year

1 - 3 years

4 - 5 years

Greater than 5 years

9. Why did you visit the clinic today? What clinic or program were you visiting? Please be specific.(Required)

Alcohol and Drug

Behavioral Health

Business Office

CARE Program

Community Health

Dental

Health Navigation

Laboratory

MAT Program

Medical

Mental Health

Optometry

Pharmacy

PRC

Transportation

Other

Describe Other:(Required)

10. What do you like the most and least about the Siletz Community Health Clinic and your visit today. Any suggestions on how we can improve?(Required)

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Contact Siletz

201 SE Swan Ave.

PO Box 549

Siletz, OR 97380

541-444-2532

Monday-Friday

8:00 AM – 4:30 PM

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