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KCHC Patient Survey

(If applicable) Have you had a PAP smear?

Yes

No

Not Applicable

If NO, why?(Required)

Are you up to date with your immunizations?

Yes

No

If NO, why?(Required)

(If applicable) Have you had a mammogram?

Yes

No

Not Applicable

If NO, why?(Required)

Have you had a physical in the last year?

Yes

No

If NO, why?(Required)

Do you smoke?

Yes

No

Prefer not to answer

(If applicable) Have you had a colon screening?

Yes

No

Not Applicable

Have you felt sad or depressed?

Yes

No

Have you been to the dentist in the past year?

Yes

No

If No, why?

On a scale of 1 – 5, how easy was it to schedule an appointment?

1 being horrible, 5 being excellent

How did our Outreach staff do in assisting you when coming to the clinic?

1 being horrible, 5 being excellent

If you have used KCHC transportation in the past, how would you rate our service?

1 being horrible, 5 being excellent

Is there anything you would like to learn more about, or do you have any questions regarding the following topics?

Diabetes

STD’s

Smoking

Obesity

Nutrition

Blood Pressure

Depression

Alzheimer’s

Pregnancy

Any additional Comments:

Name

This field is for validation purposes and should be left unchanged.

Kinston Community Health Center, Inc

(252) 522-9800

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Patient Registration
Patient Portal
Pharmacy
School-Based Dental Program
Pay your bill
KCHC Employment Opportunities
About Us
Patient Information
Apply For Discounts
Advocacy

Addresses

Physical Address
324 N. Queen Street
Kinston, NC 28501
Mailing Address
P.O. Box 2278
Kinston, NC 28502
Kinston Community Behavioral Health Center
107 S. Queen St.
Kinston, NC 28501

This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims
including medical malpractice claims, for itself and its covered individuals.
2025 Kinston Community Health Center, Inc