Patient Satisfaction Survey Questions
Please complete items 1-2:
What type of visit?  Please check the box below
Rate your care experience with the following:  Please select Yes or No
1.  Was it easy to make an appointment?
Questions:                                                      Yes/No
2.  Did you wait a long time before being seen by the doctor?
3.  Was the staff friendly and helpful?
4.  Did your doctor listen carefully to your problem?
5.  Did your doctor provide you with good care?
6.  Did you make another appointment at this time?
7.  Would you send your friends to our clinic?
Are there any comments you would like tom make?
Thank you for taking part in this survey.  Please remember all your answers are confidential!
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2670 South White Rd.
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San Jose, CA 95148
P: (408)729-9700
F: (866) 931-7822
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