{"id":351,"date":"2024-06-26T19:15:50","date_gmt":"2024-06-26T19:15:50","guid":{"rendered":"https:\/\/lssnetworkofhope.org\/lsshealthcenter\/?page_id=351"},"modified":"2025-01-27T13:08:40","modified_gmt":"2025-01-27T18:08:40","slug":"patient-survey","status":"publish","type":"page","link":"https:\/\/lssnetworkofhope.org\/lsshealthcenter\/patient-survey\/","title":{"rendered":"Patient Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"351\" class=\"elementor elementor-351\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7f0552a8 e-con-full e-flex e-con e-parent\" data-id=\"7f0552a8\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-4ebbe41c e-con-full e-flex e-con e-child\" data-id=\"4ebbe41c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-242ea42c e-con-full e-flex e-con e-child\" data-id=\"242ea42c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-b526a81 e-flex e-con-boxed e-con e-child\" data-id=\"b526a81\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-280c7fbe elementor-widget elementor-widget-heading\" data-id=\"280c7fbe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Patient Survey<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-794ca63b e-flex e-con-boxed e-con e-child\" data-id=\"794ca63b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3b20757 e-flex e-con-boxed e-con e-parent\" data-id=\"3b20757\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fea57ae elementor-widget elementor-widget-heading\" data-id=\"fea57ae\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Satisfaction Survey<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-363ecf4 elementor-widget elementor-widget-text-editor\" data-id=\"363ecf4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Your feedback about your experience at LSS Health Center is important to us! We appreciate you completing our patient satisfaction survey. This helps us to continuously improve our quality of care.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-035b471 e-flex e-con-boxed e-con e-parent\" data-id=\"035b471\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e375586 elementor-widget elementor-widget-shortcode\" data-id=\"e375586\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar 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3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework survey_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_9' style='display:none'><div id='gf_9' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_9' id='gform_9' class='survey' action='\/lsshealthcenter\/wp-json\/wp\/v2\/pages\/351#gf_9' data-formid='9' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_9_9\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_9'>\n\t\t\t<div class='gchoice gchoice_9_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Male'  id='choice_9_9_0' onchange='gformToggleRadioOther( this )'  tabindex='20'  \/>\n\t\t\t\t\t<label for='choice_9_9_0' id='label_9_9_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Female'  id='choice_9_9_1' onchange='gformToggleRadioOther( this )'  tabindex='21'  \/>\n\t\t\t\t\t<label for='choice_9_9_1' id='label_9_9_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Transgender'  id='choice_9_9_2' onchange='gformToggleRadioOther( this )'  tabindex='22'  \/>\n\t\t\t\t\t<label for='choice_9_9_2' id='label_9_9_2' class='gform-field-label gform-field-label--type-inline'>Transgender<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Non-Binary\/Gender Non-Conforming'  id='choice_9_9_3' onchange='gformToggleRadioOther( this )'  tabindex='23'  \/>\n\t\t\t\t\t<label for='choice_9_9_3' id='label_9_9_3' class='gform-field-label gform-field-label--type-inline'>Non-Binary\/Gender Non-Conforming<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Prefer to self-describe'  id='choice_9_9_4' onchange='gformToggleRadioOther( this )'  tabindex='24'  \/>\n\t\t\t\t\t<label for='choice_9_9_4' id='label_9_9_4' class='gform-field-label gform-field-label--type-inline'>Prefer to self-describe<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_9_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Prefer not to answer'  id='choice_9_9_5' onchange='gformToggleRadioOther( this )'  tabindex='25'  \/>\n\t\t\t\t\t<label for='choice_9_9_5' id='label_9_9_5' class='gform-field-label gform-field-label--type-inline'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_2\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_2'>Self-described Gender<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_9_2' type='text' value='' class='medium'   tabindex='26'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_10\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Race<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_10'>\n\t\t\t<div class='gchoice gchoice_9_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Black or African American'  id='choice_9_10_0' onchange='gformToggleRadioOther( this )'  tabindex='27'  \/>\n\t\t\t\t\t<label for='choice_9_10_0' id='label_9_10_0' class='gform-field-label gform-field-label--type-inline'>Black or African American<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='White'  id='choice_9_10_1' onchange='gformToggleRadioOther( this )'  tabindex='28'  \/>\n\t\t\t\t\t<label for='choice_9_10_1' id='label_9_10_1' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Asian'  id='choice_9_10_2' onchange='gformToggleRadioOther( this )'  tabindex='29'  \/>\n\t\t\t\t\t<label for='choice_9_10_2' id='label_9_10_2' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Native American'  id='choice_9_10_3' onchange='gformToggleRadioOther( this )'  tabindex='30'  \/>\n\t\t\t\t\t<label for='choice_9_10_3' id='label_9_10_3' class='gform-field-label gform-field-label--type-inline'>Native American<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Two or more races'  id='choice_9_10_4' onchange='gformToggleRadioOther( this )'  tabindex='31'  \/>\n\t\t\t\t\t<label for='choice_9_10_4' id='label_9_10_4' class='gform-field-label gform-field-label--type-inline'>Two or more races<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Other'  id='choice_9_10_5' onchange='gformToggleRadioOther( this )'  tabindex='32'  \/>\n\t\t\t\t\t<label for='choice_9_10_5' id='label_9_10_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Prefer not to answer'  id='choice_9_10_6' onchange='gformToggleRadioOther( this )'  tabindex='33'  \/>\n\t\t\t\t\t<label for='choice_9_10_6' id='label_9_10_6' class='gform-field-label gform-field-label--type-inline'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_4\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_4'>Other Race<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='text' value='' class='medium'   tabindex='34'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_11\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Appointment Type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_11'>\n\t\t\t<div class='gchoice gchoice_9_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Walk-in'  id='choice_9_11_0' onchange='gformToggleRadioOther( this )'  tabindex='35'  \/>\n\t\t\t\t\t<label for='choice_9_11_0' id='label_9_11_0' class='gform-field-label gform-field-label--type-inline'>Walk-in<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Scheduled'  id='choice_9_11_1' onchange='gformToggleRadioOther( this )'  tabindex='36'  \/>\n\t\t\t\t\t<label for='choice_9_11_1' id='label_9_11_1' class='gform-field-label gform-field-label--type-inline'>Scheduled<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_12\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Visit Type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_12'>\n\t\t\t<div class='gchoice gchoice_9_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Medical'  id='choice_9_12_0' onchange='gformToggleRadioOther( this )'  tabindex='37'  \/>\n\t\t\t\t\t<label for='choice_9_12_0' id='label_9_12_0' class='gform-field-label gform-field-label--type-inline'>Medical<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Dental'  id='choice_9_12_1' onchange='gformToggleRadioOther( this )'  tabindex='38'  \/>\n\t\t\t\t\t<label for='choice_9_12_1' id='label_9_12_1' class='gform-field-label gform-field-label--type-inline'>Dental<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Vision'  id='choice_9_12_2' onchange='gformToggleRadioOther( this )'  tabindex='39'  \/>\n\t\t\t\t\t<label for='choice_9_12_2' id='label_9_12_2' class='gform-field-label gform-field-label--type-inline'>Vision<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Behavioral Health'  id='choice_9_12_3' onchange='gformToggleRadioOther( this )'  tabindex='40'  \/>\n\t\t\t\t\t<label for='choice_9_12_3' id='label_9_12_3' class='gform-field-label gform-field-label--type-inline'>Behavioral Health<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Case Management \/ Care Coordination'  id='choice_9_12_4' onchange='gformToggleRadioOther( this )'  tabindex='41'  \/>\n\t\t\t\t\t<label for='choice_9_12_4' id='label_9_12_4' class='gform-field-label gform-field-label--type-inline'>Case Management \/ Care Coordination<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_7\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >For each statement below, tell us how much you agree based on today's visit to the health center.\n5 - Strongly Agree\n4 - Agree\n3 - Unsure\n2 - Disagree\n1 - Strongly Disagree<\/div><fieldset id=\"field_9_8\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Staff members are friendly and respectful.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_8'>\n\t\t\t<div class='gchoice gchoice_9_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='5'  id='choice_9_8_0' onchange='gformToggleRadioOther( this )'  tabindex='42'  \/>\n\t\t\t\t\t<label for='choice_9_8_0' id='label_9_8_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='4'  id='choice_9_8_1' onchange='gformToggleRadioOther( this )'  tabindex='43'  \/>\n\t\t\t\t\t<label for='choice_9_8_1' id='label_9_8_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3'  id='choice_9_8_2' onchange='gformToggleRadioOther( this )'  tabindex='44'  \/>\n\t\t\t\t\t<label for='choice_9_8_2' id='label_9_8_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2'  id='choice_9_8_3' onchange='gformToggleRadioOther( this )'  tabindex='45'  \/>\n\t\t\t\t\t<label for='choice_9_8_3' id='label_9_8_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1'  id='choice_9_8_4' onchange='gformToggleRadioOther( this )'  tabindex='46'  \/>\n\t\t\t\t\t<label for='choice_9_8_4' id='label_9_8_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_20\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The health center is clean and attractive.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_20'>\n\t\t\t<div class='gchoice gchoice_9_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='5'  id='choice_9_20_0' onchange='gformToggleRadioOther( this )'  tabindex='47'  \/>\n\t\t\t\t\t<label for='choice_9_20_0' id='label_9_20_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='4'  id='choice_9_20_1' onchange='gformToggleRadioOther( this )'  tabindex='48'  \/>\n\t\t\t\t\t<label for='choice_9_20_1' id='label_9_20_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='3'  id='choice_9_20_2' onchange='gformToggleRadioOther( this )'  tabindex='49'  \/>\n\t\t\t\t\t<label for='choice_9_20_2' id='label_9_20_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='2'  id='choice_9_20_3' onchange='gformToggleRadioOther( this )'  tabindex='50'  \/>\n\t\t\t\t\t<label for='choice_9_20_3' id='label_9_20_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='1'  id='choice_9_20_4' onchange='gformToggleRadioOther( this )'  tabindex='51'  \/>\n\t\t\t\t\t<label for='choice_9_20_4' id='label_9_20_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_19\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The location of the health center is convenient.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_19'>\n\t\t\t<div class='gchoice gchoice_9_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='5'  id='choice_9_19_0' onchange='gformToggleRadioOther( this )'  tabindex='52'  \/>\n\t\t\t\t\t<label for='choice_9_19_0' id='label_9_19_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='4'  id='choice_9_19_1' onchange='gformToggleRadioOther( this )'  tabindex='53'  \/>\n\t\t\t\t\t<label for='choice_9_19_1' id='label_9_19_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_19_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='3'  id='choice_9_19_2' onchange='gformToggleRadioOther( this )'  tabindex='54'  \/>\n\t\t\t\t\t<label for='choice_9_19_2' id='label_9_19_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_19_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='2'  id='choice_9_19_3' onchange='gformToggleRadioOther( this )'  tabindex='55'  \/>\n\t\t\t\t\t<label for='choice_9_19_3' id='label_9_19_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_19_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='1'  id='choice_9_19_4' onchange='gformToggleRadioOther( this )'  tabindex='56'  \/>\n\t\t\t\t\t<label for='choice_9_19_4' id='label_9_19_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_18\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I did not have to wait too long during my appointment.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_18'>\n\t\t\t<div class='gchoice gchoice_9_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='5'  id='choice_9_18_0' onchange='gformToggleRadioOther( this )'  tabindex='57'  \/>\n\t\t\t\t\t<label for='choice_9_18_0' id='label_9_18_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='4'  id='choice_9_18_1' onchange='gformToggleRadioOther( this )'  tabindex='58'  \/>\n\t\t\t\t\t<label for='choice_9_18_1' id='label_9_18_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='3'  id='choice_9_18_2' onchange='gformToggleRadioOther( this )'  tabindex='59'  \/>\n\t\t\t\t\t<label for='choice_9_18_2' id='label_9_18_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='2'  id='choice_9_18_3' onchange='gformToggleRadioOther( this )'  tabindex='60'  \/>\n\t\t\t\t\t<label for='choice_9_18_3' id='label_9_18_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='1'  id='choice_9_18_4' onchange='gformToggleRadioOther( this )'  tabindex='61'  \/>\n\t\t\t\t\t<label for='choice_9_18_4' id='label_9_18_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_17\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >The care I received met my needs.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_17'>\n\t\t\t<div class='gchoice gchoice_9_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='5'  id='choice_9_17_0' onchange='gformToggleRadioOther( this )'  tabindex='62'  \/>\n\t\t\t\t\t<label for='choice_9_17_0' id='label_9_17_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='4'  id='choice_9_17_1' onchange='gformToggleRadioOther( this )'  tabindex='63'  \/>\n\t\t\t\t\t<label for='choice_9_17_1' id='label_9_17_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='3'  id='choice_9_17_2' onchange='gformToggleRadioOther( this )'  tabindex='64'  \/>\n\t\t\t\t\t<label for='choice_9_17_2' id='label_9_17_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='2'  id='choice_9_17_3' onchange='gformToggleRadioOther( this )'  tabindex='65'  \/>\n\t\t\t\t\t<label for='choice_9_17_3' id='label_9_17_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='1'  id='choice_9_17_4' onchange='gformToggleRadioOther( this )'  tabindex='66'  \/>\n\t\t\t\t\t<label for='choice_9_17_4' id='label_9_17_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_16\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I am not worried about the cost of my care at the health center.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_16'>\n\t\t\t<div class='gchoice gchoice_9_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='5'  id='choice_9_16_0' onchange='gformToggleRadioOther( this )'  tabindex='67'  \/>\n\t\t\t\t\t<label for='choice_9_16_0' id='label_9_16_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='4'  id='choice_9_16_1' onchange='gformToggleRadioOther( this )'  tabindex='68'  \/>\n\t\t\t\t\t<label for='choice_9_16_1' id='label_9_16_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='3'  id='choice_9_16_2' onchange='gformToggleRadioOther( this )'  tabindex='69'  \/>\n\t\t\t\t\t<label for='choice_9_16_2' id='label_9_16_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='2'  id='choice_9_16_3' onchange='gformToggleRadioOther( this )'  tabindex='70'  \/>\n\t\t\t\t\t<label for='choice_9_16_3' id='label_9_16_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='1'  id='choice_9_16_4' onchange='gformToggleRadioOther( this )'  tabindex='71'  \/>\n\t\t\t\t\t<label for='choice_9_16_4' id='label_9_16_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_15\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I would recommend the health center to others.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_15'>\n\t\t\t<div class='gchoice gchoice_9_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='5'  id='choice_9_15_0' onchange='gformToggleRadioOther( this )'  tabindex='72'  \/>\n\t\t\t\t\t<label for='choice_9_15_0' id='label_9_15_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='4'  id='choice_9_15_1' onchange='gformToggleRadioOther( this )'  tabindex='73'  \/>\n\t\t\t\t\t<label for='choice_9_15_1' id='label_9_15_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='3'  id='choice_9_15_2' onchange='gformToggleRadioOther( this )'  tabindex='74'  \/>\n\t\t\t\t\t<label for='choice_9_15_2' id='label_9_15_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='2'  id='choice_9_15_3' onchange='gformToggleRadioOther( this )'  tabindex='75'  \/>\n\t\t\t\t\t<label for='choice_9_15_3' id='label_9_15_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_15_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='1'  id='choice_9_15_4' onchange='gformToggleRadioOther( this )'  tabindex='76'  \/>\n\t\t\t\t\t<label for='choice_9_15_4' id='label_9_15_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_14\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I feel safe when approaching or leaving the health center.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_14'>\n\t\t\t<div class='gchoice gchoice_9_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='5'  id='choice_9_14_0' onchange='gformToggleRadioOther( this )'  tabindex='77'  \/>\n\t\t\t\t\t<label for='choice_9_14_0' id='label_9_14_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='4'  id='choice_9_14_1' onchange='gformToggleRadioOther( this )'  tabindex='78'  \/>\n\t\t\t\t\t<label for='choice_9_14_1' id='label_9_14_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='3'  id='choice_9_14_2' onchange='gformToggleRadioOther( this )'  tabindex='79'  \/>\n\t\t\t\t\t<label for='choice_9_14_2' id='label_9_14_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='2'  id='choice_9_14_3' onchange='gformToggleRadioOther( this )'  tabindex='80'  \/>\n\t\t\t\t\t<label for='choice_9_14_3' id='label_9_14_3' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='1'  id='choice_9_14_4' onchange='gformToggleRadioOther( this )'  tabindex='81'  \/>\n\t\t\t\t\t<label for='choice_9_14_4' id='label_9_14_4' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_13\" class=\"gfield gfield--type-radio gfield--type-choice numbered gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I think the health center has everything needed to provide complete healthcare.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_13'>\n\t\t\t<div class='gchoice gchoice_9_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='5'  id='choice_9_13_0' onchange='gformToggleRadioOther( this )'  tabindex='82'  \/>\n\t\t\t\t\t<label for='choice_9_13_0' id='label_9_13_0' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='4'  id='choice_9_13_1' onchange='gformToggleRadioOther( this )'  tabindex='83'  \/>\n\t\t\t\t\t<label for='choice_9_13_1' id='label_9_13_1' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_13_2'>\n\t\t\t\t\t<input 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gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_22\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wait Times<\/legend><div class='gfield_description' id='gfield_description_9_22'>If you felt that your wait time was too long, please tell us more about why. (Check each box that applies.)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_22'><div class='gchoice gchoice_9_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='I waited a long time in the waiting room after I checked in.'  id='choice_9_22_1' tabindex='87'  aria-describedby=\"gfield_description_9_22\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_22_1' id='label_9_22_1' class='gform-field-label gform-field-label--type-inline'>I waited a long time in the waiting room after I checked in.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='I waited a long time for the provider\/staff to come see me.'  id='choice_9_22_2' tabindex='88'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_22_2' id='label_9_22_2' class='gform-field-label gform-field-label--type-inline'>I waited a long time for the provider\/staff to come see me.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_22_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.3' type='checkbox'  value='The provider\/staff spent too much time discussing things other than the reason for my visit.'  id='choice_9_22_3' tabindex='89'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_22_3' id='label_9_22_3' class='gform-field-label gform-field-label--type-inline'>The provider\/staff spent too much time discussing things other than the reason for my visit.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_22_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.4' type='checkbox'  value='I waited a long time for the nurse to come schedule my next appointment. (medical only)'  id='choice_9_22_4' tabindex='90'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_22_4' id='label_9_22_4' class='gform-field-label gform-field-label--type-inline'>I waited a long time for the nurse to come schedule my next appointment. 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