Patient Survey

Was this your first time at Open Cities Health Center?
YesNoPrefer not to say

Which of these services did you visit?
Medical (Primary Care, Women's Health, Pediatrics, Veterans Health)Behavioral HealthDentalOptometryPharmacyTelehealth

If you made your appointment over the phone, did our scheduling staff help you to the best of their ability?
YesNoOther

When you arrived, were you greeted and assisted in a timely manner by the front desk staff?
YesNoOther

Which provider did you see?

After you were checked in, did your provider see you in a timely manner?
YesNoOther

Did your provider listen to your concerns and answer any questions you had about your care?
YesNoOther

How affordable do you find the services at our health center?
Very affordableSomewhat affordableNeither affordable nor unaffordableSomewhat unaffordableVery unaffordable

In the past 12 months, has cost ever prevented you from getting medical, dental, or behavioral health care when you needed it?
YesNo

Before your visit today, were you aware that our health center offers a sliding fee discount program based on income?
YesNoNot sure

Are there any comments you wish to share about your experience?