Please help us evaluate our services by answering the following questions about your experience with us today. All answers are anonymous.

* 1. For what type of organization do you work?

* 2. Who did you meet with today?

* 3. Were you treated with respect and courtesy by: (Please check all that apply)

  Yes No
Reception Staff
Center Staff (With whom you had the appointment)
Other

* 4. Did you meet with Center Staff at your agreed upon appointment time?

* 5. Did you feel that the center representative listened to you and was attentive to your needs?

* 6. Did you feel that your concerns were addressed and adequately resolved?

* 7. Did Center Staff present in a professional manner?

* 8. Did you find the facility and grounds to be clean, attractive and well-maintaned?

* 9. How would you improve the experience you had today with SPVMHC?

* 10. What did you like most about the experience you had today with SPVMHC?

* 11. What did you like least about the experience you had today with SPVMHC?

Thank you for helping us to improve what we do!

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