Patient Satisfaction Survey

We want to give you the best possible medical care. To do that, we need your feedback. Please let us know what you think we are doing right and how we can improve by filling out the following survey. All of your responses will be kept strictly confidential and your signature is not required. Please use this opportunity to respond freely.

    Date:

    How long have you been our patient:

    Age:

    Gender:

     

    Rate the following services using number 1-5 with,
    1 (Poor) 2 (Fair) 3 (Moderate) 4 (Good) 5 (Great)

     

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    Thank you for taking the time to complete this survey. As always, we will do our best to provide you with quality care for the whole family.

    EHP Ltd. Management