Patient Satisfaction Survey

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About Us
Locations
Services
Patients
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Careers

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About Us
Locations
Services
Patients
Community
Careers

Pharmacy

My Chart

Donate

Holiday Notice: All CHSI locations will be closed on Monday, September 1st, in observance of Labor Day.
We will reopen on Tuesday, September 2nd, with normal business hours.

NOTICE: All CHSI locations will have modified hours and close early on March 15th, 2024. Please contact your nearest CHSI Health Center for their specific closing times.

Please tell us how you feel about the services we provide in order to ensure we are meeting your needs. Your responses are directly responsible for improving these services.

Date of your visit *

Which health center did you visit? *

Which service(s) did you visit? *

My call was answered within 3 rings

Yes
No
N/A

The staff that I encountered throughout the clinic were helpful and courteous

Yes
No
N/A

Waiting time in the reception area was reasonable

Yes
No
N/A

My doctor gave me the respect and time I needed to express my concerns

Yes
No
N/A

I was given a copy of my patient plan after my visit today

Yes
No
N/A

The clinic helps me obtain specialty care for my eyes (Optometry), teeth (Dental), and mental well-being (Behavioral Health)

Yes
No
N/A

I feel my Care Team (my provider, nurse, and medical assistants) cares about me

Yes
No
N/A

I am satisfied with the care I received today from my Care Team

Yes
No
N/A

I will refer a friend or relative to the clinic in the future

Yes
No
N/A

Suggestions & Comments

Would you like to be contacted by our customer service team?

Yes
No

If yes, please provide contact information below

Name

Phone Number

Name

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