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

Treatment of Veterans Out Side The United States

Name *

First

Last

Phone

Email *

How satisfied are you with *

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Communication	Communication Very Unsatisfied	Communication Unsatisfied	Communication Neutral	Communication Satisfied	Communication Very Satisfied
Service	Service Very Unsatisfied	Service Unsatisfied	Service Neutral	Service Satisfied	Service Very Satisfied
Company Overall	Company Overall Very Unsatisfied	Company Overall Unsatisfied	Company Overall Neutral	Company Overall Satisfied	Company Overall Very Satisfied

How is VA Foreign Medical Services Compared to The Department of Veterans Affairs *

VA Foreign Medical Services Gives Better Service to Veterans	VA Foreign Medical Services Gives adequate Care to Veterans Like Care at VA	VA Foreign Medical Services Gives Substandard Care to Veterans	VA Foreign Medical Services Gives. Poor Care to Vetertans	Department of Veterans Affairs should work with VA Foreign Medical Services to Improve Care for Veterans!
Would Recommend VA Foreign Medical Services VA Foreign Medical Services Gives Better Service to Veterans	Would Recommend VA Foreign Medical Services VA Foreign Medical Services Gives adequate Care to Veterans Like Care at VA	Would Recommend VA Foreign Medical Services VA Foreign Medical Services Gives Substandard Care to Veterans	Would Recommend VA Foreign Medical Services VA Foreign Medical Services Gives. Poor Care to Vetertans	Would Recommend VA Foreign Medical Services Department of Veterans Affairs should work with VA Foreign Medical Services to Improve Care for Veterans!

Please Answer Questions Honestly!

Likert Scale

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Cares About Veterans	Cares About Veterans Strongly Disagree	Cares About Veterans Disagree	Cares About Veterans Neutral	Cares About Veterans Agree	Cares About Veterans Strongly Agree
Honest With Veterans	Honest With Veterans Strongly Disagree	Honest With Veterans Disagree	Honest With Veterans Neutral	Honest With Veterans Agree	Honest With Veterans Strongly Agree
Takes time to hear Problems from Veterans	Takes time to hear Problems from Veterans Strongly Disagree	Takes time to hear Problems from Veterans Disagree	Takes time to hear Problems from Veterans Neutral	Takes time to hear Problems from Veterans Agree	Takes time to hear Problems from Veterans Strongly Agree

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