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HEALTH CENTER

Satisfaction Survey


Tell us how we're doing - we want to hear from you!

This brief survey is your opportunity to provide comments and feedback about your experience and level of care while at the Health Center. We value your input and appreciate your taking the time to fill out this form.


Your Name: (Optional)  

Your E-mail: (Optional) 

Your Phone: (Optional)  

If you supplied your e-mail address or phone number above, do you wish to receive a response from a Health Center staff member?  Yes No

When (what day) did you visit the Health Center?

What did we do well?

What did we do poorly?

How can we improve?

       


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