Patient Visit Survey (English)

Horizon Family Medicine Patient Visit Survey

Your Privacy is Protected. All information that would let someone identify you or your family will be kept private. Your responses to this survey are also completely confidential. Your Participation is Voluntary. You may choose to answer this survey or not. If you choose not to, this will not affect the health care you get.

  • Provider and Location

  • Access to the Clinic

  • Please tell us how satisfied you are with the following areas of care:

  • Our Staff

  • Communication

  • Care Coordination

  • Overall Satisfaction


  • Your answers are confidential, but please share some information with us to help us better tailor our services to our patients


  • Thank you for providing us with this valuable information that we will use to improve your care.

  • This field is for validation purposes and should be left unchanged.