The following survey is designed to help us improve our quality of care based on your feedback.  If there are areas in which you think we could improve, we want to know about it! Your satisfaction is very important to us and we appreciate you taking a couple minutes to complete the form below! 

Where did you receive care today?

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* 1. Where did you receive care today?

Which care provider did you see today?

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* 2. Which care provider did you see today?

What is your age?

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* 3. What is your age?

Do you consider yourself Hispanic or Latino

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* 4. Do you consider yourself Hispanic or Latino

Please rate your ability to get appointments for check-ups, yearly exams, well visits, regular follow-up visits?

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* 5. Please rate your ability to get appointments for check-ups, yearly exams, well visits, regular follow-up visits?

Please rate your ability to get appointments when you're sick

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* 6. Please rate your ability to get appointments when you're sick

Please rate our staff's ability to answer your questions in a way that you could understand

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* 7. Please rate our staff's ability to answer your questions in a way that you could understand

Did someone talk to you about your health goals during your visit?

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* 8. Did someone talk to you about your health goals during your visit?

Did someone ask you if there was a period of time when you felt sad or depressed?

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* 9. Did someone ask you if there was a period of time when you felt sad or depressed?

Overall, please rate your satisfaction with the care you received.

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* 10. Overall, please rate your satisfaction with the care you received.

Is there anything else you think we should know about your experience at our practice?

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* 11. Is there anything else you think we should know about your experience at our practice?

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