Patient Disability Survey 2026

Patient Disability Survey

Please answer the questions below to the best of your ability to help us improve your experience.
Selected language
As a CHA patient, have you ever been asked about having a disability or whether you need support for a disability for a medical visit at CHA?
If yes, what went well as part of that discussion?
If yes, what could have been improved?
Do you or a family member have a disability that requires support or an accommodation to attend medical visits at CHA?
If yes, were your needs met to attend your most recent medical visit?
If yes, what went well during this visit?
If yes, what could be improved?
Where was your last visit where you were screened for disability?
Would you like to be contacted by a CHA staff member to discuss your feedback?

If so, please share your name and phone number below:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty: