Patient Satisfaction Survey
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Your opinion counts!
We would like to hear from you if you have recently been a patient at one of our facilities.
Your responses will help us improve our services.

Date and time of your appointment:

At which facility were you scheduled?

Please select your age range:

Please rate the services you received during your visit:

Was the staff courteous to you and your family?

What do you think of the health center's hours? Are they convenient for you?

Please rate the cleanliness of the health center:

Did you have any problems making an appointment?

What did you think of the waiting time for your appointment?

Have you received services at this health center before?

Why did you choose this health center?

Would you return to this facility?

Did your child receive immunizations?

Were you satisfied with the information you received about the immunizations?

Are there other services you would like to see us offer that would assist you and your family? (optional):

Do you have any other recommendations that you think will help us improve our services?

Would you like someone to contact you about this survey?
If so, please enter your preferred contact method below.

Please enter your e-mail address (optional):

Thank you for your participation!