SATISFACTION SURVEY

Tell Us How We're Doing!

We take your experience & opinions seriously. Please tell us about the care you’ve received through PHA Wellness.  You may answer the questionnaire anonymously if you wish.

  • If you saw more than one provider at our clinic, we would appreciate your feedback on both services.
  • Quality of Service You Received:

  • Please enter a value between 1 and 5.
    (1-disagree, 2- somewhat disagree, 3 -neutral, 4-mostly agree, 5- strongly agree)
  • Please enter a value between 1 and 5.
    (1-disagree, 2- somewhat disagree, 3 -neutral, 4-mostly agree, 5- strongly agree)
  • Please enter a value between 1 and 5.
    (1-disagree, 2- somewhat disagree, 3 -neutral, 4-mostly agree, 5- strongly agree)
  • Please enter a value between 1 and 5.
    (1-disagree, 2- somewhat disagree, 3 -neutral, 4-mostly agree, 5- strongly agree)
  • Please enter a value between 1 and 5.
    (1-disagree, 2- somewhat disagree, 3 -neutral, 4-mostly agree, 5- strongly agree)
  • If yes, please fill out the information below.
  • Ease, Convenience, Efficiency, Comfort

  • Please enter a value between 1 and 5.
    (1-very dissatisfied, 2-somewhat dissatisfied, 3-neutral, 4-somewhat satisfied, 5-very satisfied)
  • Please enter a value between 1 and 5.
    (1-very dissatisfied, 2-somewhat dissatisfied, 3-neutral, 4-somewhat satisfied, 5-very satisfied)
  • Please enter a value between 1 and 5.
    (1-very dissatisfied, 2-somewhat dissatisfied, 3-neutral, 4-somewhat satisfied, 5-very satisfied)
  • Please enter a value between 1 and 5.
    (1-very dissatisfied, 2-somewhat dissatisfied, 3-neutral, 4-somewhat satisfied, 5-very satisfied)
  • Please enter a value between 1 and 5.
    (1-very dissatisfied, 2-somewhat dissatisfied, 3-neutral, 4-somewhat satisfied, 5-very satisfied)
  • Thank You!

    We appreciate your feedback so that we may improve the services we provide.