Wufoo
Website Satisfaction Survey
Thanks for taking a few minutes to answer this survey. Your input will help us improve the Legacy Health System website.
Questions with a red * are required.
Are you a...
*
Patient
Friend or family of a Legacy patient
Clinician
Community Partner
Job Seeker
Individual looking for healthcare services
Other
(Select all that apply)
If you checked, "Other" above, please specify:
What brings you to Legacy Health System's website:
*
Get health information (about a specific illness or medical condition or general information)
See if Legacy accepts my insurance
Get more info about services in an advertisement I heard/saw
Find out about residency programs
Find directions or hours for a specific hospital or clinic
Find a doctor
Learn about Legacy Health System's health services
Learn about Legacy Health System's community involvement
Find a job with Legacy Health System
Make a donation
Find a class
Other
(Select all that apply)
If you checked, "Other", please specify below:
Did you find what you were looking for?
*
Yes
No
If not, can you let us know what you were specifically looking for?
How did you find our website?
*
Typed/Bookmarked the website
Search Engine (Google, Yahoo!, MSN Live Search, AOL, etc.)
I have a brochure with the website URL on it
TV/Radio ad
Print ad
Other
If you checked, "Other", please specify below:
Where do you live?
*
NW Portland
NE Portland
SW Portland
SE Portland
Gresham/Troutdale/Sandy
Oregon City/Milwaukie/Gladstone
West Linn/Lake Oswego
Tualatin/Tigard
Beaverton
Wilsonville
Woodburn
Hillsboro
McMinnville/Newberg/Sherwood
Hood River
Salem/Silverton
Vancouver
Longview
Other
How often do you visit the Legacy Health System website?
*
Multiple times weekly
Once a week
A couple times a month
Seldom
This is my first time
What do you like about it?
What would you like to see improved?
Would you be interested in any of the following?
Register for a class online
Sign up for a health newsletter
Tips for Healthy Living
Online Chat with a Nurse
Access your health records and history online
Schedule appointments online
Communicate with your doctor online
(Select all that apply)
Do you have any additional thoughts to share with us?
What is your gender?
Male
Female
Which age range do you fall within?
18-25
26-34
35-55
55+
If you are interested in being part of a follow up survey by phone, please provide your name and phone number below:
Name
First
Last
Phone
-
(###)
-
###
####
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