Patient Experience Survey 2020

Patient Experience Survey 2020

Your experience means a lot to us. If you are not comfortable answering any questions just skip it and move on. Thank you for sharing your responses, it helps us do a better job!
1. Have you received any services at Evergreen Health, Community Access Services or the Pride Center of WNY in the last year?

Yes No

2. At which location do you receive our services? (Please select all that apply)

206 South Elmwood Avenue Bailey - Testing & PrEP (3297 Bailey Avenue) Southern Tier (320 Prather Avenue, 31 Water Street, 408 West 5th Street) Mathews Building - Care Coordination (282 Delaware Avenue) Pride Center of WNY (278 Delaware Avenue)

3. How long have you been receiving services?

Less than 6 months Less than 1 year 1-2 years More than 2 years

4. How did you hear about our services? (Please select all that apply)

Social Media Friend or Family Internet/Website Billboard/Bus Shelter Radio/TV Newspaper/Magazine

If you have any questions or concerns please call 716-847-2441 to speak with one of our operators!
Thanks! You are done. Easy, right? But wait, we don’t want you to go away empty handed.

If you want to be entered for a chance at a $50 Wegmans/Amazon/Visa/Tops gift card, just leave us a way to contact you below. Don’t worry though, your name will never be associated with your answers to the survey.
Name:
Phone Number:
Email:
Other Contact:
Any Additional Comments:
Should be Empty: