Community Health Resource Center

Palo Alto Medical Foundation is pleased to provide health-related information to our patients and community members. We value your opinion about the services of the Community Health Resource Center. Thank you for your time in completing this survey.

1) Location of the CHRC:





2) The reason for my visit was to gather information regarding (check all that apply):










3) The information is for (check all that apply):








4) I will use the information to (check all that apply):









5) The information I received came from (check all that apply):











6) I received assistance from (check all that apply):








7) I would rate the assistance I received as:









8)


9) My age range:








10) Gender:



11) I learned about the CHRC through:











12) Palo Alto Medical Foundation patient:



Thank you for your participation!


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