2024 Patient Experience Survey
We want to hear from you! Take this quick survey about your patient experience for a chance to win a $50 gift card. Results will remain anonymous, even if you submit your contact information for a chance to win a gift card at the end of this survey.
At which location to you receive services?
S. Elmwood Ave.
Hertel Ave.
Bailey Ave. (Community Access Services, Primary & Specialty Care)
Community Dr.
Prather Ave.
278 Delaware Ave. (Pride Center of WNY)
What services do you receive?
Medical Services (Primary Care, Specialty Care, STI, Pharmacy)
Dental
Behavioral Health (Substance Use, Mental Health, Syringe Exchange Program)
Supportive Services (Thrive, Housing, Transportation, MOCHA, Nutrition)
Care Coordination
Community Access Services (CAS)
Pride Center of WNY
How long have you been a patient/client?
Less than 6 months
Less than 1 year
1-2 years
More than 2 years
Please select an answer for the following questions.
Always
Mostly
Sometimes
Never
Are you greeted by security or front staff when you enter one of our buildings?
The Evergreen Health, Community Access Services, and Pride Center of WNY staff treat me with kindness, courtesy, and respect.
The Evergreen Health, Community Access Services, and Pride Center of WNY staff make me feel welcome.
When I call or visit Evergreen Health, Community Access Services, and Pride Center of WNY, I receive helpful service.
Evergreen Health, Community Access Services, and Pride Center of WNY staff spend enough time with me.
Evergreen Health, Community Access Services, and Pride Center of WNY staff listen carefully to me.
I am encouraged and comfortable sharing my ideas, opinions, and beliefs about my services and care.
My cultural background and unique life experiences are taken into consideration.
Evergreen Health, Community Access Services, and Pride Center of WNY staff make me feel comfortable regardless of my gender, race, ethnicity, age, religion, sexual orientation, identity, or income.
Evergreen Health, Community Access Services, and Pride Center of WNY staff use my preferred pronouns and names.
I would recommend Evergreen Health, Community Access Services, and Pride Center of WNY to other people.
Please rate your overall patient experience.
Lowest
1
2
3
4
Highest
5
1 is Lowest, 5 is Highest
How can we improve your patient experience?
DEMOGRAPHICS
What is your age?
18 -24
25 -29
30 -39
40 - 49
50 - 59
60+
What was your sex when you were born?
Male
Female
Intersex
How do you identify?
Man/boy
Woman/girl
Transgender Man/boy
Transgender Woman/girl
Non-binary/Genderqueer
Something Else
Are you of Hispanic or Latinx origin or descent?
Yes, Hispanic or Latinx
No, Not Hispanic or Latinx
What is your race? (You can pick more than one)
White
Black/African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Multiracial
Other race
Are you a veteran?
Yes
No
What is your primary language?
English
Spanish
Other
Counting yourself, how many people live in your household?
1
2
3
4
5
6
7
8
More than 8
What is your yearly household income?
Less than $13,000
$13,000-$39,499
$39,500-$49,999
$50,000-$74,999
$75,000-$99,999
Over $100,000
What is your zip code?
Enter your contact information for a chance to win a $50 gift card!
Your information will not be linked with your survey answers. Survey results are anonymous.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Submit
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