Southern California Medical Center

Appointment Information

Patient Name Appointment Date *
Provider Name Location *

Satisfaction Questions

The comfort and cleanliness of the waiting area.
Your wait time in the office.
The professionalism and helpfulness of your receptionist
Your physician/provider's personal manner (Courtesy, Respect, Sensitivity and Friendliness)
Responsiveness of clinical staff to patient's needs
The service/care provided was valuable to improve your health.
How likely are you to recommend us to a friend or colleague?
Do our current clinic hours work for you?
Please let us know if you have any suggestions or recommendations.



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