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Patient Perception Survey

Patient Perception And Satisfaction Survey

You have recently recieved services from Bethina Health Care. We want to insure that we met your needs and provided quality care. You can help us by rating our service by responding to the following questions. Please return this form to our agency at your earliest convenience.
In your opinion, how can the agency improve?

Please complete this form so we can meet your needs in the future and if a problem exists, can correct it. We are dependent on your imput.

Name:
Phone:
-
E-mail:*
If you do elect to sign the form, would you allow us to call you to clarify and questions :
Input your initial for signature

HOUSTON OFFICE

1234 Birchstone Dr.,
Missouri City Texas, 77459

Tel.: 1.832-884-6186
       1.281-499-5949

Fax: 281-499-8343

BEAUMONT OFFICE

2305 North St Ste 103,
Beaumont, TX 77702

Tel.: 409-838-9995

Fax: 409-838-9993

WORKING HOURS

Mon - Fri 8:00 am - 5.00 pm
Saturday Closed
Sunday Closed