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Patient Satisfaction

We would like to know how you feel about the services we provide so we [" make maKe sure we are meeting your needs. Your responses are qlrefily responsible forlii We meellng neeos. directly responslole TOrf ii improving these services. All responses will be kept confidential and anonymous. ['': Thank you for your

time.

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Ycur Sex:

Male

Female

Yrur ftace/fthnirity:
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American lndian/Alaska Nativ* kVhits {Not Hispanic *r Latin#} I"{ispanic ar Latino {AIl Races}

Please circle how well you think we are doing in the following areas: FAIRPOOR. 1 GREATOK.

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Faeility: Neat and clean huilding:
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Wuuld you r*fer your friends and relfitives tu us? kVhat dc y#Lr like hest abcut our f,*nter?

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What do you like least about our Center?

Suggestions for i mproveme nt?
Thank you for completing our Survey!