NEPA Community Health Care | Primary & Family

Thank you for your feedback!
We’re conducting this survey to learn about your experiences with NEPA Community Health Care. This is an opportunity for you to honestly tell us how we are doing and how we might do better. Your responses to this survey are confidential, and nothing you say in this survey will affect your ability to access care at NEPA CHC in any way.
1. How likely is it that you would recommend NEPA CHC to a friend or family member?*
Not Likely At All (0) 1 2 3 4 5 6 7 8 9 Extremely Likely (10)
2. What is NEPA CHC good at?*
3. What could NEPA CHC do better?*
4. Overall, how well has NEPA CHC met your needs?*
5. How often do staff at NEPA CHC treat you with respect?*
6. How easy is it for you to get services at NEPA CHC?*
7. Please explain your answer.*
8. If offered, would you be interested in using any of the following NEPA CHC services or equipment to help you manage your health? (Check all that apply)*
- Care Management (i.e. additional support outside of your regular appointments with managing your health needs, medications, referrals to community resources, and more)
- Blood pressure cuff for home use
- Glucose monitor for home use
- Virtual check-ins with your health care team via text or patient portal
- Virtual support group for nutrition and exercise
- None of the above
9. What technology do you have reliable access to for NEPA CHC’s telehealth/virtual services? (Check all that apply)*
- Videoconferencing (e.g. Zoom, Google Meet, FaceTime)
- Smart Phone (e.g. iPhone, Android)
- Regular Phone (e.g. landline, flip phone)
- Email
- Text Messaging
- I don’t have reliable access to technology.
- I am not interested in telehealth/virtual services.
10. What are the biggest challenges you are currently facing due to the coronavirus (COVID-19)? (Check all that apply)*
- Access to Food
- Access to Housing/Shelter
- Childcare or Educational Support for Child(ren)
- Coronavirus Illness/Helping Others Who Are Ill
- Mental Health (e.g. Anxiety, Loneliness, Depression)
- Reduced Income or Unemployment
- Other (please specify in comments below)
11. How else can we support you and your health during the coronavirus pandemic?*
12. How long have you been receiving care at NEPA CHC?*
Optional Questions
The following optional and confidential questions help us understand who we serve and how we can support you. Please find the options that are the best fit for you or self-describe your response in the comment box below.
13. What is your age?
14. Gender | How do you identify?
15. Race/Ethnicity | How do you identify? (Check all that apply)
- Asian or Asian American
- Black or African American
- Hispanic or Latino/a/x
- Middle Eastern or North African
- Native American or Alaska Native
- Native Hawaiian or Other Pacific Islander
- White
- Another Race or Ethnicity (please describe in comments below)
16. How did you hear about us?
- Relative or Friend
- Social Media or Website
- Community Event
- School
- Information Flyer
- Other (Please Specify)
Please use this space to describe any of the alternative selections you made for the questions in this survey.
Follow Up | If you would like NEPA CHC staff to follow up with you about your survey responses or health needs, please enter your name and contact information. This is completely OPTIONAL.

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Thank you for your feedback!

Optional Questions