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* Have you ever heard of Judson Health Center?
Yes No
 
 

* Have you heard of Gouverneur Healthcare Services?
Yes No
 
 

What is your preferred language?
English Spanish Chinese Other  
 
 

* Do you live in the Soho/Nolita area?
Yes No
 
 

* Do you work in or around Soho/Nolita?
No Yes
 
 

* What health insurance do you have?
None Medicare Medicaid Private Insurance Other  
 
 

How do you choose your healathcare provider?
Family/Friend recommendation Convenience to home Found name through my insurance Convenience to my work Other  
 
 

* How often do you go to the doctor?
Once per year 5-10 times per year 2-5 times per year 10+ times per year
 
 
 
* Have you ever visited Judson Health Center?
 
No
 
Yes
 
 
 
Overall, how would you rate Judson?
 
Excellent
 
Good
 
Average
 
Poor
 
Terrible
 
Not Sure
 
 
 
How satisfied are you with your service from Judson?
 
Extremely satisfied
 
Very satisfied
 
Neutral
 
Very dissatisfied
 
Extremely dissatisfied
 
 
 
Would you recommend Judson to a friend?
 
Yes
 
No
 
Not Sure
 
 
 
If no, why not?
   
 
 
 
For your NEXT medical visit, how likely are you to seek out care at Judson Health Center?
 
Definitely would
 
Probably would
 
Might or might not
 
Probably would not
 
Definitely would not
 
N/A
 
 
 
What are the THREE main reasons you didn't get health care services from another health center?
   
 
   
 
   
 
 
 
What would you change about the process of seeing your healthcare provider (i.e. making the appointment, location, cost, facility appearance etc) at Judson?
   
 
 
 
Are there any other comments you have for Judson?
   
 
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