Immunization Clinic Client Satisfaction Survey

Thank you for completing the survey. Your feedback will help us improve the services we provide to you and our community.

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* 1. Where did you receive your services?

Mesa Immunization Clinic

Roosevelt Immunization Clinic

West Valley Immunization Clinic

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* 2. Did you receive the immunization services you needed?

Yes

No

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* 3. If no, did the nurse help you find a solution?

Yes

No

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* 4. How would you rate the professionalism of staff?

Poor

Fair

Good

Excellent

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* 5. How would you rate your experience at this clinic?

Poor

Fair

Good

Excellent

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* 6. Would you recommend this clinic to others?

Yes

No

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* 7. Comments or Suggestions

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* 8. OPTIONAL: Provide your name and contact information for an opportunity to win a prize!

Name

Phone Number