Patient Satisfaction Survey (Family Planning Center)

Instructions: Please complete the following survey. Your responses will be used to improve our services. All responses are anonymous. Thank you for your time.

Please select the response that best matches how you feel.

Questions	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
The location of the clinic is convenient for me.	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
My provider listened to me today.	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
My provider took enough time with me today.	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree

How did you hear about us?

Friend

Relative

Partner

Online

Referral

Other…