We would like to know how you feel about the treatment you are receiving at Community Health Center of Cape Cod. Your opinion is important because it helps us to know what we do well and what needs improvement. Your responses are confidential. Thank you for your help.

Question Title

* 1. Which office did you visit and what was the date?

Date
Date
Date
Date

Question Title

* 2. Please indicate your race

Question Title

* 3. Please indicate your ethnicity:

T