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
Administration Office
Goal of Foothill Community Health Center

Foothill Community Health Center sites are Federal Tort Claims Act (FTCA) deemed facilities. Foothill Community Health Center is a 501 (c)3 non-profit community-based Federally Qualified Health Center (FQHC) offering comprehensive medical, dental, mental health, and specialty healthcare services. Foothill Community Health Center is a Health Center Program grantee under 42 U.S.C. 254b, and deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
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