At Downeast Health Services, customer satisfaction is very important.  We need to hear from you what we do well and what we need to improve upon.  Your confidential comments will be sent directly to Kathie Norwood, Executive Director.  Thank you for completing this satisfaction survey. 

Your Name – optional

 		 Date of visit:
 
Please rate the level of satisfaction with your experience:

 

 
Additional Comments

 

 
Additional Comments
Care or service:

 

 
Additional Comments
Overall Visit:

 

 
Additional Comments
How long did you wait?
None      10 min      15 min     20 min     30 min     45 min    
If longer than 45 minutes how long did you have to wait?

 
Would you recommend us to a friend? Yes         No

 
How did you learn about us?

 
Tell us about your visit.

 
Are you willing to return for follow up care or access additional services? Yes         No

 
Other Comments:

 
If you would like to be contacted concerning your survey, please complete the following information or you may contact Kathie Norwood, Executive Director at 667-5304 ext 238 or at knorwood@downeasthealth.org.
Address:
City, State, Zip:
Phone or phones:
Email: