Your privacy is very important to us. Your answers will be kept secure and anonymous. They will not change or affect the individual care you receive from staff at Summit Community Care Clinic. The data collected will be used solely for the purpose of informing Summit’s needs assessment, strategic planning, and considerations for future growth. Your valuable insights will help us enhance our services and focus on areas that matter most to our patients. Thank you for participating and contributing to the improvement of our healthcare services.

As a token of our appreciation for your participation in this survey, there will be a random drawing from the pool of survey participants. Those selected will have the chance to receive a $25 gift card to Walmart (10 winners).

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* 1. What is your age?

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* 2. 5-digit zip code where you live:

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* 3. What is your gender?

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* 4. Which of the following best describes your race and/or ethnicity? (Check all that apply)

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* 5. Do you have health insurance?

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* 6. If you responded yes, do you have:

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* 7. Do you have reliable internet access?

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* 8. What is your experience with telehealth?

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* 9. Do you have a primary care provider (PCP)?

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* 10. If you responded yes (Q9), how satisfied are you with your primary care provider?

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* 11. Do you have a dentist or dental clinic you visit regularly?

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* 12. If you responded yes (Q11), how satisfied are you with your dentist/dental clinic?

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* 13. Do you access behavioral health or mental health services?

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* 14. If you responded yes (Q13), how satisfied are you with your behavioral health/mental health services?

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* 15. Do you or your immediate family members face difficulty getting health care services? Check all that apply

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* 16. If you responded yes to question 15, what are the main challenges faced by you or your family in getting healthcare? Check all that apply.

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* 17. How many times have you visited Summit Community Care in the last year?

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* 18. Do you or someone in your household have any of the following healthcare needs? (Check all that apply)

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* 19. Which social or support services are you most likely to use in your community?

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* 20. Are there enough social and support services in your community?

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* 21. Are there enough health services in your community?

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* 22. What do you think are the three most important health-related issues in your community? (Check up to 3 options)

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* 23. What do you think are the three most important “risky behaviors” in your community?

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* 24. How would you rate your own personal health?

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* 25. What additional services or programs would you like to see offered at Summit Community Care Clinic?

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* 26. If you’d like to be in the drawing for the gift card, please list your first name and preferred contact information here (email address, phone, or mailing address here):

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* 27. Is there anything else you would suggest that Summit improve or change?

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* 28. Thanks again for taking our survey! Winners of the gift cards will be notified by July 1st. Is there anything else that you feel is important to share on this survey?

 
 100% of survey complete.

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