Satisfaction Survey

At Community Health Services, we value each and every one of our patient’s opinions regarding the care and treatment received at our offices. The feedback we obtain is used to make changes and improvements within our system.

Please take a moment to tell us how we are doing by completing the survey below. All surveys with patient names will be held in the strictest confidence and will not be shared with employees and/or Providers.

Providing the highest quality standards in the health care industry in a customer friendly environment has been our goal for 40 years. Thanks again for taking the time to complete the survey, it is greatly appreciated

Patient Information

Patient Name: (not required)

Patient Gender:

Patient Age:

Patient Race/Ethnicity:

Office Location:

Name of Provider: