Patient Satisfaction Survey

1. About This Survey

This survey should only take a few minutes to complete - thank you for taking the time to share your feedback with us.

Please share your feedback about the care you receive at Mid-State. Your responses are used to improve the patient experience and are shared with our staff. All responses will be kept anonymous unless you otherwise indicate.

PLEASE NOTE: This survey is not under a secure connection.

Mid-State Health Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Mid-State Health Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Français (French) ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.

Question Title

* 1. Date of visit:

Date

Question Title

* 2. Where was the visit?

Plymouth Office

Bristol Office

Question Title

* 3. Are you completing this survey on behalf of someone else.

Yes

Your relationship to the patient:

20% of survey complete.