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Submission: On November 30 via manual from US — Scanned from DE
Submission: On November 30 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: surveyform — POST /?e534c4ydbrk8t897rt77k8rk
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<div><!-- react-empty: 6 --><input type="hidden" name="is_embedded" id="is_embedded" value="false">
<header><a class="layout_skipNav" href="#content">Skip to Content</a>
<div class="layout_layoutContainer">
<div class="layout_mainHeader layout_clearfix">
<div class="layout_mainHeaderLeft">
<h1 class="layout_invisibleTitle" tabindex="0" aria-label="Survey"></h1><img class="layout_logo" src="https://sb-static.voice.va.gov/abbe49dc0e375d6fde5b6ea482ed0400e9255cba" alt="U.S. Department of Veterans Affairs Logo">
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<div class="layout_mainHeaderRight"><span id="languageSelector" class=""><!-- react-empty: 17 --><input type="hidden" name="lang" id="activeLang" value="en"></span></div>
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<div class="layout_text textNode">
<div style="display:block; clear:none; margin-bottom: 40px;">
<div class="textNode" tabindex="0" style="display: block; float: left; text-align: left; font-size: 13px; clear: none; line-height: 1.3em; width: 67%;">
<p>The VA provides free, confidential support 24/7 for Veterans and their family and friends. If you are in crisis, contact the <b>Veterans Crisis Line:</b> Dial 988 (Press 1) or 1 (800) 273-8255 (Press 1), text 838255, or visit
<a href="https://www.veteranscrisisline.net" target="_blank">https://www.veteranscrisisline.net</a>. If you are homeless or at risk of homelessness, contact the <b>National Call Center for Homeless Veterans</b> (NCCHV) by dialing 1
(877) 424-3838 or visiting <a href="https://www.va.gov/HOMELESS/" target="_blank">https://www.va.gov/HOMELESS/</a>.</p>
</div>
<div class="textNode" tabindex="0" style="display: block; float: right; text-align: left; font-size: 13px; clear: none; line-height: 1.3em; width: 25%;">
<p> OMB Number: 2900-0876 <br> Expiration: 03/31/2023 <br> Estimated Burden: 2 minutes </p>
</div>
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</div>
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<div class="htmlBlock">
<div class="layout_text textNode" style="clear:left;" tabindex="0">
<br>
<span style="font-size: 40px;"><strong>Help us serve you better</strong></span>
<br>
<br>
<span style="font-size: 22px;"> We want to hear about the health care appointment you made on November 28, 2022. By indicating how much you agree or disagree with the statements below, you directly help us improve VA services. </span>
<br>
<br>
<span style="font-size: 17px;"> This survey should take you approximately 2 minutes to complete. <br>
<br>
</span>
</div>
</div>
<fieldset class="questionBlock ratingGridQuestion ratingGridQuestion_hasOneRow">
<legend class="question_questionTitle" id="3"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span class="questionCaption"><b>It was easy to get my appointment.</b> <u>Required</u></span></legend>
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<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Neither Agree nor Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Agree</span></div>
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<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
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<legend class="question_questionTitle" id="4"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span class="questionCaption"><b>I got my appointment on a date and time that worked for me.</b> <u>Required</u></span></legend>
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<div class="table_table rowOption_rowOptionContainer ratingGridRow">
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<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Agree</span></div>
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<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
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<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">5</span>
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<legend class="question_questionTitle" id="5"><span class="questionCaption"><b>When scheduling my appointment, I was treated with courtesy and respect.</b></span></legend>
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<div class="table_table rowOption_rowOptionContainer ratingGridRow">
<div aria-hidden="true" class="row_row">
<div class="cell_cell rowOption_anchorsContainer">
<div class="table_table anchors anchors_isFirstRow table_table_hasFixedLayout">
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<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Disagree</span></div>
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<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Neither Agree nor Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Agree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Agree</span></div>
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<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
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<div class="cell_cell selectionBar_selectionUnit layout_answer">
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<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">4</span>
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<div class="cell_cell selectionBar_selectionUnit layout_answer">
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<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">5</span>
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<div class="table_table rowOption_rowOptionContainer ratingGridRow">
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<div class="cell_cell rowOption_anchorsContainer">
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<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Neither Agree nor Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Agree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Agree</span></div>
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</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_satisfaction_scale5sat_3" aria-required="true"
aria-describedby="6 6_onf_q_vavoice_trx_apt_satisfaction_scale5sat___19KQuC" aria-label="3 Neither Agree nor Disagree" class="cellOption_input" data-mds-value="3" data-representative-value="3"
name="onf_q_vavoice_trx_apt_satisfaction_scale5sat" value="3">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_satisfaction_scale5sat_4" aria-required="true"
aria-describedby="6 6_onf_q_vavoice_trx_apt_satisfaction_scale5sat___19KQuC" aria-label="4 Agree" class="cellOption_input" data-mds-value="4" data-representative-value="4"
name="onf_q_vavoice_trx_apt_satisfaction_scale5sat" value="4">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">4</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_satisfaction_scale5sat_5" aria-required="true"
aria-describedby="6 6_onf_q_vavoice_trx_apt_satisfaction_scale5sat___19KQuC" aria-label="5 Strongly Agree" class="cellOption_input" data-mds-value="5" data-representative-value="5"
name="onf_q_vavoice_trx_apt_satisfaction_scale5sat" value="5">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">5</span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
<fieldset class="questionBlock ratingGridQuestion ratingGridQuestion_hasOneRow">
<legend class="question_questionTitle" id="7"><span class="questionCaption"><b>During my most recent VA health care experience, I felt respected and comfortable.</b></span></legend>
<div class="layout_answers">
<div class="table_table rowOption_rowOptionContainer ratingGridRow">
<div aria-hidden="true" class="row_row">
<div class="cell_cell rowOption_anchorsContainer">
<div class="table_table anchors anchors_isFirstRow table_table_hasFixedLayout">
<div class="row_row">
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Neither Agree nor Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Agree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Agree</span></div>
</div>
</div>
</div>
</div>
<div class="row_row">
<div class="cell_cell">
<div class="rowOption_selectionUnits">
<div class="table_table selectionBar_selectionBarContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_comfortable_scale5sat_1"
aria-describedby="7 7_onf_q_vavoice_trx_apt_comfortable_scale5sat___Tvxv7V" aria-label="1 Strongly Disagree" class="cellOption_input" data-mds-value="1" data-representative-value="1"
name="onf_q_vavoice_trx_apt_comfortable_scale5sat" value="1">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">1</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_comfortable_scale5sat_2"
aria-describedby="7 7_onf_q_vavoice_trx_apt_comfortable_scale5sat___Tvxv7V" aria-label="2 Disagree" class="cellOption_input" data-mds-value="2" data-representative-value="2"
name="onf_q_vavoice_trx_apt_comfortable_scale5sat" value="2">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">2</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_comfortable_scale5sat_3"
aria-describedby="7 7_onf_q_vavoice_trx_apt_comfortable_scale5sat___Tvxv7V" aria-label="3 Neither Agree nor Disagree" class="cellOption_input" data-mds-value="3" data-representative-value="3"
name="onf_q_vavoice_trx_apt_comfortable_scale5sat" value="3">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_comfortable_scale5sat_4"
aria-describedby="7 7_onf_q_vavoice_trx_apt_comfortable_scale5sat___Tvxv7V" aria-label="4 Agree" class="cellOption_input" data-mds-value="4" data-representative-value="4" name="onf_q_vavoice_trx_apt_comfortable_scale5sat"
value="4">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">4</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_apt_comfortable_scale5sat_5"
aria-describedby="7 7_onf_q_vavoice_trx_apt_comfortable_scale5sat___Tvxv7V" aria-label="5 Strongly Agree" class="cellOption_input" data-mds-value="5" data-representative-value="5"
name="onf_q_vavoice_trx_apt_comfortable_scale5sat" value="5">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">5</span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
<fieldset class="questionBlock ratingGridQuestion ratingGridQuestion_hasOneRow">
<legend class="question_questionTitle" id="8"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span class="questionCaption"><b>I trust Kansas City VA Medical Center for my health care needs.</b> <u>Required</u></span></legend>
<div class="layout_answers">
<div class="table_table rowOption_rowOptionContainer ratingGridRow">
<div aria-hidden="true" class="row_row">
<div class="cell_cell rowOption_anchorsContainer">
<div class="table_table anchors anchors_isFirstRow table_table_hasFixedLayout">
<div class="row_row">
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Neither Agree nor Disagree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Agree</span></div>
<div aria-hidden="true" class="cell_cell anchor anchor_customStyles anchor_5column anchor_isOnFirstRow"><span id="matrix-column_undefined">Strongly Agree</span></div>
</div>
</div>
</div>
</div>
<div class="row_row">
<div class="cell_cell">
<div class="rowOption_selectionUnits">
<div class="table_table selectionBar_selectionBarContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_trust_scale5sat_1" aria-required="true"
aria-describedby="8 8_onf_q_vavoice_trx_trust_scale5sat___WzCBPK" aria-label="1 Strongly Disagree" class="cellOption_input" data-mds-value="1" data-representative-value="1" name="onf_q_vavoice_trx_trust_scale5sat"
value="1">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">1</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_trust_scale5sat_2" aria-required="true"
aria-describedby="8 8_onf_q_vavoice_trx_trust_scale5sat___WzCBPK" aria-label="2 Disagree" class="cellOption_input" data-mds-value="2" data-representative-value="2" name="onf_q_vavoice_trx_trust_scale5sat" value="2">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">2</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_trust_scale5sat_3" aria-required="true"
aria-describedby="8 8_onf_q_vavoice_trx_trust_scale5sat___WzCBPK" aria-label="3 Neither Agree nor Disagree" class="cellOption_input" data-mds-value="3" data-representative-value="3" name="onf_q_vavoice_trx_trust_scale5sat"
value="3">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">3</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_trust_scale5sat_4" aria-required="true"
aria-describedby="8 8_onf_q_vavoice_trx_trust_scale5sat___WzCBPK" aria-label="4 Agree" class="cellOption_input" data-mds-value="4" data-representative-value="4" name="onf_q_vavoice_trx_trust_scale5sat" value="4">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">4</span>
</div>
</div>
</div>
</div>
<div class="cell_cell selectionBar_selectionUnit layout_answer">
<div class="cellOption_cellOptionContainer" data-has-answer="false" data-should-display-as-selected="false"><input type="radio" id="onf_q_vavoice_trx_trust_scale5sat_5" aria-required="true"
aria-describedby="8 8_onf_q_vavoice_trx_trust_scale5sat___WzCBPK" aria-label="5 Strongly Agree" class="cellOption_input" data-mds-value="5" data-representative-value="5" name="onf_q_vavoice_trx_trust_scale5sat" value="5">
<div aria-hidden="true" class="cellOption_indicatorContainer">
<div aria-hidden="true" class="indicatorCircle_indicatorCircleContainer indicatorCircle">
<div class="indicatorCircle_circle"></div><span class="indicatorCircle_label">5</span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
<div class="longform_longformContainer questionBlock singleSelectQuestion">
<fieldset>
<legend class="question_questionTitle" id="9"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span
class="questionCaption"><b>Do you have a child or children that need care when you attend medical appointments? This includes a child or children whom you are a caretaker for (i.e., grandparent or relative).</b> <u>Required</u></span>
</legend>
<div class="longform_groupContainer">
<div class="layout_answers longform_group"><!-- react-text: 405 --><!-- /react-text -->
<ul class="group_group">
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-yes">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_va_trx_apt_childcareappt_yn_1" aria-describedby="9" aria-label="Yes" class="option_input" data-mds-value="1"
name="onf_q_va_trx_apt_childcareappt_yn" value="1"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">Yes</span></div>
</div>
</div>
</div>
</li>
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-no">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_va_trx_apt_childcareappt_yn_2" aria-describedby="9" aria-label="No" class="option_input" data-mds-value="2"
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<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">No</span></div>
</div>
</div>
</div>
</li>
</ul>
</div>
</div>
</fieldset>
</div>
<div class="longform_longformContainer questionBlock singleSelectQuestion lnf_hide">
<fieldset>
<legend class="question_questionTitle" id="10"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span class="questionCaption"><b>If VA were to provide options for childcare during your VA medical appointments, which of the options would you most prefer?</b> <u>Required</u></span>
</legend>
<div class="longform_groupContainer">
<div class="layout_answers longform_group"><!-- react-text: 434 --><!-- /react-text -->
<ul class="group_group">
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-i-would-prefer-va-to-reimburse-me-for-my-current-childcare-arrangement">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_va_trx_apt_childcareoptions_radio_1" aria-describedby="10" aria-label="I would prefer VA to reimburse me for my current childcare arrangement"
class="option_input" data-mds-value="1" value="1" hidden-name="onf_q_va_trx_apt_childcareoptions_radio"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">I would prefer VA to reimburse me for my current childcare arrangement</span></div>
</div>
</div>
</div>
</li>
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-i-would-prefer-va-provide-childcare-at-or-near-the-va-medical-facility">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_va_trx_apt_childcareoptions_radio_2" aria-describedby="10" aria-label="I would prefer VA provide childcare at or near the VA medical facility"
class="option_input" data-mds-value="2" value="2" hidden-name="onf_q_va_trx_apt_childcareoptions_radio"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">I would prefer VA provide childcare at or near the VA medical facility</span></div>
</div>
</div>
</div>
</li>
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-i-would-prefer-va-offer-access-to-licensed-childcare-that-is-separate-from-va">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_va_trx_apt_childcareoptions_radio_3" aria-describedby="10"
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class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">I would prefer VA offer access to licensed childcare that is separate from VA</span></div>
</div>
</div>
</div>
</li>
</ul>
</div>
</div>
</fieldset>
</div>
<div class="questionBlock singleDropdownQuestion">
<fieldset class="">
<legend class="question_questionTitle"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span
class="questionCaption"><b>Would you like to provide additional feedback with a concern, compliment, or recommendation about your experience(s) with Kansas City VA Medical Center? Please select from one of the following options.</b>
<u>Required</u></span></legend>
<div class="layout_answers">
<div>
<div class="layout_notMobileScreenOnly"><!-- react-text: 473 --><!-- /react-text -->
<div class="dropdown_dropdownContainer layout_answer singleDropdown_dropdownWrapper">
<div class="dropdown_dropdownSelector dropdown_dropdownSelector_isInactive" role="button" tabindex="0" aria-haspopup="true" aria-expanded="false">
<div class="dropdown_dropdownTitle">- Select your response -</div><i aria-hidden="true" class="medallicons_medallicons dropdown_dropdownIcon"></i>
</div>
<div role="application">
<ul role="menu" class="dropdown_dropdownList">
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-compliment"><!-- react-text: 481 -->Compliment<!-- /react-text --></li>
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-concern"><!-- react-text: 483 -->Concern<!-- /react-text --></li>
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-recommendation"><!-- react-text: 485 -->Recommendation<!-- /react-text --></li>
<li role="menuitem" tabindex="-1" class="dropdown_dropdownListItem" data-test-name="option-will-not-provide-additional-feedback"><!-- react-text: 487 -->Will not provide additional feedback<!-- /react-text --></li>
</ul>
</div>
</div>
</div>
<div class="layout_mobileScreenOnly"><!-- react-text: 489 --><!-- /react-text -->
<div class="dropdown_dropdownContainer layout_answer singleDropdown_dropdownWrapper">
<div class="dropdown_dropdownSelector dropdown_dropdownSelector_isInactive" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0">
<div class="dropdown_dropdownTitle">- Select your response -</div><i aria-hidden="true" class="medallicons_medallicons dropdown_dropdownIcon"></i>
</div>
</div>
</div>
</div><input type="hidden" id="dd_q_vavoice_trx_feedbacktype" name="dd_q_vavoice_trx_feedbacktype" value="">
</div>
</fieldset>
</div>
<div class="questionBlock textareaQuestion">
<fieldset>
<div class="question_questionTitle" id="12"><span
class="questionCaption"><b>Use the text box below to enter details of the additional feedback (optional). Please do not include any personally identifiable information, Social Security Number, Veteran ID, or medical information, but do provide details about your experience.</b></span>
</div>
<div class="layout_answers">
<div class="textarea_textareaContainer layout_answer">
<div class="textarea_textareaContainerOverflowHidden"><textarea class="textarea_textarea" name="spl_q_vavoice_trx_experience_txt" id="spl_q_vavoice_trx_experience_txt" maxlength="400" aria-labelledby="12"
aria-describedby="spl_q_vavoice_trx_experience_txt_CharCount" aria-label="Comment box"></textarea></div>
</div>
<div id="spl_q_vavoice_trx_experience_txt_CharCount" class="textarea_textareaCount" aria-live="assertive" aria-atomic="true" aria-busy="true"><span><!-- react-text: 505 -->0<!-- /react-text --><!-- react-text: 506 -->
<!-- /react-text --></span><span class="textarea_textareaCharacterTyped">Characters Typed </span><!-- react-text: 508 -->/ <!-- /react-text --><!-- react-text: 509 -->400<!-- /react-text --></div>
</div>
</fieldset>
</div>
<div class="longform_longformContainer questionBlock singleSelectQuestion">
<fieldset>
<legend class="question_questionTitle" id="13"><span class="validation_validationBlock validationMessage validation_requiredBlock"><i aria-hidden="true" class="medallicons_medallicons validation_validationIcon"></i><span
class="validation_caption">Required</span></span><span class="questionCaption"><b>Can VA contact you about your feedback?</b> <u>Required</u></span></legend>
<div class="longform_groupContainer">
<div class="layout_answers longform_group"><!-- react-text: 519 --><!-- /react-text -->
<ul class="group_group">
<li class="group_optionContainer">
<div class="layout_answer" data-test-name="option-yes,-va-can-contact-me-about-my-patient-experience.">
<div id="JAWS_CLICK_TARGET" class="table_table option_optionContainer table_table_hasFixedLayout">
<div class="row_row">
<div class="cell_cell option_indicatorContainer"><input type="radio" id="onf_q_vavoice_trx_veteran_contact_enum_1" aria-describedby="13" aria-label="Yes, VA can contact me about my patient experience." class="option_input"
data-mds-value="1" name="onf_q_vavoice_trx_veteran_contact_enum" value="1"><span class="indicatorRadio_indicatorRadioContainer option_indicator indicatorRadio"></span></div>
<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">Yes, VA can contact me about my patient experience.</span></div>
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<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">No, I do not want VA to contact me about my patient experience.</span></div>
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<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">Yes</span></div>
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<div class="cell_cell option_captionContainer"><span aria-hidden="true" class="option_caption">No</span></div>
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<p style="font-size:90%;"><span class="comment_survey">We are asking for this information so that you can provide compliments, recommendations, or concerns to <span class="va_entity">VA</span><span class="rcs_entity">Readjustment
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data from this survey or other sources to ensure the final scores truly and accurately represent the experiences of Veterans. </span><span class="edu_entity">This survey is used to inform Congressional legislation and budgets to help
the VA better serve Veterans with educational assistance. The information gathered from this survey will be maintained and stored in a secure survey platform. VA will not disclose information collected on this form to any source other
than what has been authorized under the Privacy Act of 1974. Your response is voluntary. Giving us your information is voluntary. Refusal to provide your information will not result in the denial of benefits. VA will not deny an
individual benefits for refusing to provide information asked within this survey. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching
programs with other agencies. This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of
information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average </span><span class="CWV_paperworkReduction">The Center for Women Veterans is exempt from
the Paperwork Reduction Act as found in the Public Law (P.L.) 103 section 509, 318(d). </span><span class="paperworkReduction">This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title
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displayed. Valid OMB control numbers can be located on the OMB Internet Page at
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Skip to Content The VA provides free, confidential support 24/7 for Veterans and their family and friends. If you are in crisis, contact the Veterans Crisis Line: Dial 988 (Press 1) or 1 (800) 273-8255 (Press 1), text 838255, or visit https://www.veteranscrisisline.net. If you are homeless or at risk of homelessness, contact the National Call Center for Homeless Veterans (NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/. OMB Number: 2900-0876 Expiration: 03/31/2023 Estimated Burden: 2 minutes Help us serve you better We want to hear about the health care appointment you made on November 28, 2022. By indicating how much you agree or disagree with the statements below, you directly help us improve VA services. This survey should take you approximately 2 minutes to complete. RequiredIt was easy to get my appointment. Required Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 RequiredI got my appointment on a date and time that worked for me. Required Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 When scheduling my appointment, I was treated with courtesy and respect. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 RequiredI am satisfied with the service I received from Kansas City VA Medical Center. Required Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 During my most recent VA health care experience, I felt respected and comfortable. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 RequiredI trust Kansas City VA Medical Center for my health care needs. Required Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree 1 2 3 4 5 RequiredDo you have a child or children that need care when you attend medical appointments? This includes a child or children whom you are a caretaker for (i.e., grandparent or relative). Required * Yes * No RequiredIf VA were to provide options for childcare during your VA medical appointments, which of the options would you most prefer? Required * I would prefer VA to reimburse me for my current childcare arrangement * I would prefer VA provide childcare at or near the VA medical facility * I would prefer VA offer access to licensed childcare that is separate from VA RequiredWould you like to provide additional feedback with a concern, compliment, or recommendation about your experience(s) with Kansas City VA Medical Center? Please select from one of the following options. Required - Select your response - * Compliment * Concern * Recommendation * Will not provide additional feedback - Select your response - Use the text box below to enter details of the additional feedback (optional). Please do not include any personally identifiable information, Social Security Number, Veteran ID, or medical information, but do provide details about your experience. 0 Characters Typed / 400 RequiredCan VA contact you about your feedback? Required * Yes, VA can contact me about my patient experience. * No, I do not want VA to contact me about my patient experience. Would you like to volunteer your demographic information to help VA better serve you? * Yes * No Next We are asking for this information so that you can provide compliments, recommendations, or concerns to VAReadjustment Counseling Service (RCS) Vet Centers. By filling out this survey, you are authorizing VARCS Vet Centers database access to retrieve Veteran contact information to follow up with you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared regarding your experience with VARCS Vet Centers. Your contact information and response may be referred to the Veterans Crisis Line if an automated review indicates your response may be concerning. The Veterans Crisis Line may contact you for follow up as a result of that referral. VARCS Vet Centers may utilize individual Veteran survey data from this survey or other sources to ensure the final scores truly and accurately represent the experiences of Veterans. This survey is used to inform Congressional legislation and budgets to help the VA better serve Veterans with educational assistance. The information gathered from this survey will be maintained and stored in a secure survey platform. VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974. Your response is voluntary. Giving us your information is voluntary. Refusal to provide your information will not result in the denial of benefits. VA will not deny an individual benefits for refusing to provide information asked within this survey. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies. This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average The Center for Women Veterans is exempt from the Paperwork Reduction Act as found in the Public Law (P.L.) 103 section 509, 318(d). This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 1 minute2 minutes3 minutes4 minutes5 minutes6 minutes to review the instructions and complete this survey. The results of this survey will be used to inform opportunities for program improvement in the quality of VARCS Vet Centers services. Participation in this survey is voluntary, and your decision not to respond will have no impact on VA benefitsVA or RCS Vet Centers confidentiality, benefits or services which you may currently be receiving. . This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this survey will lead to improvements in the quality of service delivery by helping to improve educational assistance programs. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.VARCS Vet Centers cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided by law. Privacy Policy If you have additional questions or concerns, please reach out to the Veterans Experience Office.