Patient Outcome/Satisfaction Survey

Patient Outcome/Satisfaction Survey

Patient ID

Compared to your last visit to EHA Clinics, are you feeling better today? *

On a scale from 1-5, how will you rate the overall service you received at EHA Clinics? *

If rating is below 3, can you tell us why your experience at EHA Clinics was not satisfactory.

Thank you for your time, do you have any other feedback you would like to share?

Date of Visit