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.

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* 1. Date of visit:


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* 2. Where was the visit?

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

20% of survey complete.