We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services and you can enter as much information as you want. All responses will be kept Confidential. Thank you for your time.
Which location did you receive services at? Please select Bakersfield Downey Fresno Glendale Long Beach Los Angeles (Downtown) Los Angeles (West) Mission Hills Modesto Montclair Oakland Orange Riverside Rosemead San Bernadino San Diego (North) San Diego (Downtown) Santa Ana Torrance *
Please assign a letter grade describing your overall experience with Family Planning Associates Medical Group: A (Exceptional) B (Above Average) C (Average) D (Below Average) F (Unacceptable)
If you have any future family planning needs, would you return to Family Planning Associates Medical Group? Yes No
What did you like best about our facility?
Is there anything you would like Family Planning Associates to improve upon?
If anyone in our office particularly impressed you with his or her professionalism or kindness, please tell us who:
Survey Number (if known)
What type of service did you receive from Family Planning Associates? First Trimester Surgical Abortion Second Trimester Surgical Abortion Non-surgical Abortion Essure Tubal Sterilization STD Testing Pap Smear Other
Date of Service ... *
Please rate our performance in the following specific areas:
The convenience of your appointment date and time? Very Good Average Needs Improvement
The patient representative who made your appointment? Very Good Average Needs Improvement
The front desk receptionist? Very Good Average Needs Improvement
Your Treatment Coordinator / counselor? Very Good Average Needs Improvement
The clinician (Physician, Nurse Practitioner)? Very Good Average Needs Improvement
The cleanliness and neatness of the clinic? Very Good Average Needs Improvement
Maintaining your overall privacy? Very Good Average Needs Improvement
The following information is optional, but is required if you wish to be contacted
First & Last Name
Phone Number
(Important!!! If you have a MEDICAL concern regarding your current medical condition,you must contact our offices directly at 1-877-88-FPAMG or 1-877-883-7264)
Thank you. Your opinions are very important to us and will help to improve our practice.
FPAMG Home Page
