1. Demographic Information

We are committed to meeting your health care needs, and your responses to these questions will allow us to identify what we are doing well, and things that need to be improved.

Please help us by answering the following questions about your recent experience with FSH Outpatient Services either at the hospital or in the community. 

Answers from all people surveyed will be gathered together and presented in a report used to improve our services. Your answers are confidential; they will not be separately reproduced in this report.

Note participation in the survey is voluntary. 




* 1. Date you attended the clinic.

Date / Time
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* 2. What is your gender?

* 3. What age group are you in?

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