VAFMS MEDICAL SERVICES

VA FOREIN Medical Services E.I.N -301168216 R.N.C-1-31-607748

Secure Fax Number:980.216.6020 Secure Fax Number:980.216.6020

Customer Satisfaction Survey

Today's Date *

Time of and date of last visit?

Date

Time

How easy was it to schedule an appointment with our facility?

How would you rate the overall care you received from your provider?

How would you rate your doctor explaining your Diagnosis to you?

Please Rate Your Experience With Us: *

	Very Poor	Poor	Neutral	Good	Great
Knowledge	Knowledge Very Poor	Knowledge Poor	Knowledge Neutral	Knowledge Good	Knowledge Great
Helpfulness	Helpfulness Very Poor	Helpfulness Poor	Helpfulness Neutral	Helpfulness Good	Helpfulness Great
Communication	Communication Very Poor	Communication Poor	Communication Neutral	Communication Good	Communication Great
Proactive customer service	Proactive customer service Very Poor	Proactive customer service Poor	Proactive customer service Neutral	Proactive customer service Good	Proactive customer service Great

Did We Solve Your Issue? *

How Could We Improve Our Service? *

Would You Use Our Service Again? *

One thought on “Customer Satisfaction Survey”

A WordPress Commenter says:
November 4, 2022 at 1:06 pm
Hi, this is a comment.
To get started with moderating, editing, and deleting comments, please visit the Comments screen in the dashboard.
Commenter avatars come from Gravatar.

Comments are closed.