Patient Feedback Survey | U.S. HealthWorks Medical Group

Patient Feedback

	Thank you for for taking the time to give us your feedback regarding any issue or concern you may have with U.S. HealthWorks.

	Date of Visit (mm/dd/yyyy)
	Select Medical Center State
	Select Medical Center

	What was the main reason for your visit?

	How did you first learn about U.S. HealthWorks?
	Other

	How would you rate the service you received from the following?
	Front Desk:
	Medical Assistant:
	Medical Provider:
	Physical Therapist:
	Orthopedic Specialist:
	X-Ray Technologist:

	How would you rate the following aspects of our medical group?
	Hours of Operation::
	Scheduling:
	Convenience of Location:
	Visibility of Location:
	Appearance:
	Parking:
	Cleanliness:
	Waiting Time:

	How satisfied are you with the overall quality of care provided by U.S. HealthWorks?

	How can we improve our service to you?


	The following optional information will help us to investigate and identify problems to better serve you and your employer.
	Name:
	Company Name:
	Address:
	City:
	State:
	Zip:
	Phone:
	Email Address:

Corporate Office:
U.S. HealthWorks
25124 Springfield Court
Suite 200
Valencia, CA 91355
Phone: 661-678-2600
Fax: 661-678-2700

To contact a specific center, click on
"FIND MEDICAL CENTER"

Your Opinion Matters:
Tell us your experience at our center(s) and how we can improve