Patient Satisfaction Survey
Thank you for trusting EHC with your healthcare. This short survey (about 3 minutes) helps us learn what we’re doing well and where we can make your experience even better. Your answers are confidential and will never affect your care. Thank you for helping us grow and for strengthening our commitment to providing better care for the whole community.
Date of your visit
-
Month
-
Day
Year
Date
Department or service you visited (check all that apply):
Gender Affirming Hormone Therapy
Abortion Care
Behavioral Health
STI testing or treatment
Birth Control / Emergency Contraception
Annual Wellness Exam
HIV testing / HIV prevention (PrEP)
Peri- and Postmenopausal Care
Breast/Chest care
Infection Check (UTI, BV testing/treatment, etc.)
Menstrual or bleeding concerns
Other
How would you rate your experience calling to schedule your appointment?
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
How would you rate the online check-in process using AthenaHealth (patient portal, medical history, online forms)?
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
How would you rate the check-in process at the front desk?
1-Poor
2-Fair
3-Good
4- Very Good
5- Excellent
How satisfied were you with the cleanliness and comfort of the facility?
1-Very Dissatisfied
2-Dissatisfied
3-Neutral
4- Satisfied
5-Very Satisfied
How would you rate your experience with the lab (vitals, blood draw, etc.)?
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
How would you rate your Provider’s care, including attentiveness, clear communication, and addressing your concerns?
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
Did you feel that EHC provided trauma-informed care?
No, I did not feel supported
Yes, I felt in control of my care
*If you identify as LGBTQIA+, how welcome and respected did you feel during your visit?
1-Not welcome at all
2-Slighlty welcome
3-Somewhat welcome
4-Mostly welcome
5-Extremely welcome and respected
*If you came to EHC for abortion care, how would you describe your experience with the process (check-in, ultrasound, counseling, and medications and/or procedure)?Do you have any feedback on how we could improve this service, or things you especially appreciated?
*If the counseling portion of your abortion care had been offered as a telehealth visit before your in-clinic appointment, would that have been of interest to you?
Yes, definitely
Maybe / not sure
No, I liked the in-person counseling
Overall, how satisfied were you with your visit?
1-Very dissatisfied
2-Dissatisfied
3-Neutral
4-Satisfied
5-Very Satisfied
Was your care completed at EHC or were you referred to another facility?
My care was completed at EHC
I was referred to another facility
How did you hear about us?
Please Select
Friend or Family Referral
Another Healthcare Provider
Insurance Company Directory
Internet Search (Google, Bing, etc)
Social Media
Advertisement (print, online)
Community Event or Outreach
Other
What did we do well during your visit?
What could we improve or add to better meet your needs?
Would you be willing to be contacted about your feedback?
Yes
No
If yes, please provide your name and contact information:
Submit
Should be Empty: