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704.393.7720

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Patient Satisfaction Survey

The C.W.Williams Community Health Center, Inc. would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services.

Age
Gender
Male Female
Race/Ethnicity:

Asian

Black/African American

White(Not Hispanic or Latino)

Unknown

Pacific islanderMale

American Indian/Alaska Native

Hispanic or Latino(All Races)

Provider I saw today was:

Dr Jones

Leslie Ware,PA

Raymond Tha,FNP

Dr Saunders

Dr Fink-Rothman

Please select how well you think we are doing in the following areas:

EASE OF GETTING CARE:
Ability to get in to be seen
Great Good Okay Fair Poor
Hours Center is open
Great Good Okay Fair Poor
Convenience of center's location
Great Good Okay Fair Poor
Prompt return on calls
Great Good Okay Fair Poor
WAITING:
Time in waiting room
Great Good Okay Fair Poor
Time in exam room
Great Good Okay Fair Poor
Waiting for tests to be performed
Great Good Okay Fair Poor
Waiting for test results
Great Good Okay Fair Poor
STAFF:
Provider: (Physician Assistant, Nurse Practitioner) Name
Listens to you
Great Good Okay Fair Poor
Takes enough time with you
Great Good Okay Fair Poor
Explains what you want to know
Great Good Okay Fair Poor
Nurses and Medical Assistants: Name
Friendly & Helpful to you
Great Good Okay Fair Poor
Gives you good advice and treatment
Great Good Okay Fair Poor
LABORATORY STAFF:
Friendly & Helpful to you
Great Good Okay Fair Poor
Answers your questions
Great Good Okay Fair Poor
ALL OTHERS:
Friendly & Helpful to you
Great Good Okay Fair Poor
Answers your questions
Great Good Okay Fair Poor
PAYMENT:
What to pay
Great Good Okay Fair Poor
Explanation of charges
Great Good Okay Fair Poor
Collection of payment/money
Great Good Okay Fair Poor
FACILITY:
Neat and clean building
Great Good Okay Fair Poor
Ease of finding where to go
Great Good Okay Fair Poor
Comfort & Safety while waiting
Great Good Okay Fair Poor
Privacy
Great Good Okay Fair Poor
CONFIDENTIALITY:
Keping personal information private
Great Good Okay Fair Poor
The likelihood of referring your friends & relatives to us
Great Good Okay Fair Poor
Do you consider the center your regular source of care?
YES NO
What type of transportation did you use to get to our center today?
We appreciate any suggestions for improvement.
You may submit anonymously or add your name if you desire:

Verification

Please enter any two digits *

Example: 12

Our Address

3333 Wilkinson Boulevard
Charlotte, NC 28208

Main Phone: 704.393.7720

Dental Clinic : 980.335.0503

Pharmacy: 980.335.0505

Patient Transportation: 704.335.0304

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