Rockingham County Public Health Customer Satisfaction Survey

1. Which department did you use on your last date of service?
  *This question is required.

• Adult Health
• Child Health
• Immunization
• Family Planning
• STD
• Labwork
• Pharmacy
• Billing Dept
• Post-partum
• WIC
• Dental
• MOUD

2. Did you need an interpreter? 

• Yes
• No

3. Were you offered interpreter services? *This question is required.

• Yes
• No
• Not needed

SOLO EN ESPAÑOL: Califique nuestro 
SPANISH ONLY: Rate our service by checking in the appropriate area.

4. ¿Qué tan bien le trató el intérprete y le facilitó la comunicación entre usted y el equipo de salud?
How well did the interpreter treat you and facilitate communication between you and the health team?     *This question is required.

• 5 - Excellent (Excelente)
• 4 - Very Good (Muy Bueno)
• 3 - Good (Bueno)
• 2 - Fair (Razonable)
• 1 - Poor (Malo)

4. ¿Cómo calificaría su satisfacción con su capacidad para acceder a la atención?
How would you rate your satisfaction with your ability to access care? *This question is required.

• 5 - Excellent (Excelente)
• 4 - Very Good (Muy Bueno)
• 3 - Good (Bueno)
• 2 - Fair (Razonable)
• 1 - Poor (Malo)

4. ¿Cómo calificaría su capacidad para comprender la información provista por su proveedor?
How would you rate your ability to understand the information provided by your provider?     *This question is required.

• 5 - Excellent (Excelente)
• 4 - Very Good (Muy Bueno)
• 3 - Good (Bueno)
• 2 - Fair (Razonable)
• 1 - Poor (Malo)

REJI

4. Please rate staffs respect for your customs or cultural beliefs. 
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

5.  Are there barriers that you can identify that may have helped you have a better client/caregiver experience? 

  *This question is required.

• Yes, there were some things that may have helped me to have a better experience
• No

6. If yes, please check which barriers that you encountered.

 

• The way client was engaged/treated by RCDPH staff
• The inability to receive and/or understand health information from RCDPH staff
• The level of comfort the client had with discussing racial, cultural, or social issues that impact health
• Other - Write In Please enter an 'other' value for this selection.

7. Would you return for a follow up visit? 
 

• Yes
• No

8. Please rate the courtesy and respect given by our staff.
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

9. Please rate the staff's respect for your privacy and conversation confidentiality?
. *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

10. Please rate the timeliness of your visit.
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

11. Please rate the quality of the services you received.
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

12. Please rate how our clinic hours of operation met your needs.
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

13. How would you rate your overall experience with our Services?
  *This question is required.

• 5 - Excellent
• 4 - Very Good
• 3 - Good
• 2 - Fair
• 1 - Poor

14. Please tell us how you heard about our Services.
  *This question is required.

• Rockingham County Public Health Website
• Friend Referral
• Family Referral
• Facebook Page
• Other - Write In Please enter an 'other' value for this selection.