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HVHD Routine Immunization Satisfaction Survey
Please complete the survey below to let HVHD know about your routine immunization experience
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* Indicates required question
How did you hear about HVHD's flu clinic services? Check all that apply.
*
Friend/Family Member
Community group (i.e. Senior Center, Library, First Selectman/Mayor, etc)
Social Media (i.e. Facebook, Instagram, LinkedIn, etc)
HVHD Website
Advertisment
Mail
Other:
Required
Why did you choose to receive your routine immunization at HVHD? Check all that apply.
*
Convenience
Returning patient
Trust in HVHD clinical staff
Other:
Required
Do you feel you were given enough information about all the vaccines you received?
*
Yes
No
Other:
On a scale of 1-10 (1 being not satisfied, 10 being great experience), how would you rate your experience?
Not satisfied
1
2
3
4
5
6
7
8
9
10
Great experience!
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On a scale of 1-10, how likely is it that you would recommend HVHD's routine immunization clinic to a friend/family member?
*
Not at all likely
1
2
3
4
5
6
7
8
9
10
Extremely likely
Do you have any other comments, questions, or concerns?
Your answer
Do you want to subscribe to HVHD's newsletter?
*
Yes
No
If yes, insert email address below.
Your answer
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