Patient Satisfaction Survey
We at KCS Health Center continue to be committed to seeking ways to improve the services we provide to our patients, with your health and safety always as our top priority. Your feedback helps our physicians, nurses, and staff know where we may improve. All responses will be kept confidential.
Date of Service
*
-
Month
-
Day
Year
Date
How did you hear about KCS? (Please select all that apply)
Mail
Email
Event
Friend/Family
Internet
Text Message
Facebook
Yelp
Instagram
Other
What location did you visit today?
*
Commonwealth Clinic
Lincoln Clinic
MacArthur Clinic
Orangethorpe Clinic
Buena Park Navigation Center
Was your service in-person or telehealth?
*
In-Person
Telehealth
Check all services you currently receive at KCS.
*
Primary Care
Dental
Behavioral Health
Acupuncture
Chiropractic
CalAIM
Medication for Opioid/Alcohol Use Disorder (MOUD/MAUD) (formally known as MAT)
Other
What service(s) did you most recently receive?
*
Primary Care
Dental
Behavioral Health
Acupuncture
Chiropractic
CalAIM
Medication for Opioid/Alcohol Use Disorder (MOUD/MAUD) (formally known as MAT)
Other
Race
*
Please Select
African American/Black
American Indian/Alaskan Native
Caucasian/White
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiian
Other Pacific Islander
Guamanian or Chamorro
Samoan
Unknown/Other
Declined
Ethnicity
*
Please Select
Hispanic/Latino
Not Hispanic/Latino
Unknown
Declined
If Hispanic/Latino
Please Select
Mexican
Mexican American
Chicano/a
Puerto Rican
Cuban
Spanish
Other Hispanic/Latino
Gender
*
Female
Male
Other
Age
*
0-18
19-24
25-30
31-50
51-64
65+
Primary Language Spoken at Home
*
English
Spanish
Korean
Chinese
Vietnamese
Other
Questions
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The KCS’ facility is convenient and accessible (i.e. open hours, location, parking space, etc.).
I was able to make an appointment in a timely manner to my satisfaction.
I am satisfied with KCS’ interpretation and translation services.
I waited less than 5 minutes at the clinic before seeing my provider.
The staff (front receptionist, medical assistant, provider) were polite, courteous, respectful, and listened to my concerns.
My provider addressed my health goals during the visit (weight loss, diabetes, hypertensions, smoking cessation, alcohol cessation, etc.).
My provider explained the importance of caring for my mental health and well-being.
My provider asked me about my housing and food situation and referred me to other services if applicable.
My provider acknowledged my needs beyond what I originally came for and recommended me other services at the clinic.
My provider spent enough time with me during my visit.
My provider was able to answer my questions and sufficiently explain my plan of care.
I received enough information to self-manage my condition.
I would recommend KCS to family members and friends.
My most recent appointment was for an urgent issue.
Yes
No
I was able to make a same day appointment for my urgent issue without any difficulties.
Yes
No
Are you aware that KCS offers a sliding fee discount scale for low-income households or individuals?
Yes
No
Did a KCS staff member explain the sliding fee program to you?
Yes
No
Do you have any ideas or suggestions for how we can improve our services? (i.e. location, services, hours, etc.)
If you are open to being contacted regarding your feedback, please provide your name and contact information.
Was this translated from a different language?
Yes
No
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