Patient Satisfaction Survey Questions
Please complete items 1-2:
What type of visit?  Please check the box below
Rate your care experience with the following:  Please select Yes or No
1.  Was it easy to make an appointment?
Questions:                                                      Yes/No
2.  Did you wait a long time before being seen by the doctor?
3.  Was the staff friendly and helpful?
4.  Did your doctor listen carefully to your problem?
5.  Did your doctor provide you with good care?
6.  Did you make another appointment at this time?
7.  Would you send your friends to our clinic?
Are there any comments you would like tom make?
Thank you for taking part in this survey.  Please remember all your answers are confidential!
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Call Us (408) 729-9700

2670 South White Rd.
Suite 200
San Jose, CA 95148
P: (408)729-9700
F: (866) 931-7822
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Mission Statement
Our mission is to provide our community with high-quality comprehensive affordable medical, dental, and counseling services at our easily accessible health clinics. Seeing a need to balance the inequalities in healthcare, Foothill Community Health Center provides health services to everyone, regardless of their ethnicity, race, gender, sexual orientation, immigration status, or ability to pay for services.
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