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Patient Satisfaction Survey
You must have JavaScript enabled to use this form.
Which Clinic did you visit?
Olean
Salamanca
Machias
How did you learn about the Health Department's Family Planning Clinic?
How did you learn about the Health Department's Family Planning Clinic?
- Select -
County Website
Health Educator
School nurse
Family/Friend
Newspaper Ad
Internet
Facebook
X/Twitter
Instagram
Billboard
Other…
Enter other…
Was it easy to make an appointment?
Yes
No
Was the front desk staff courteous and respectful?
Yes
No
Was the clinic location convenient?
Yes
No
The provider who treated me clearly explained what I needed to know
Yes
No
On the day of your appointment, how long did you wait to see the provider?
How long did you
WAIT
?
- Select -
5 - 10 minutes
11 - 20 minutes
20 - 30 minutes
More than 30 minutes
On the day of your appointment, how long was your visit with the provider?
How long was your
VISIT
?
- Select -
5 - 10 minutes
11 - 20 minutes
20 - 30 minutes
More than 30 minutes
Are you likely to refer a friend to the clinic?
Yes
No
What changes can we make to improve your clinic experience
Leave this field blank
