Feedback Form

Name*

City*

Reason For Your Treatment*

How long was the wait before your appointment?*

Our service was delivered in a kind, calming, and caring manner:*

How would you describe the treatment you received at Venice Beach Surgical Center?*

Dr. Augusto Rojas and his staff are readily available to me when I have questions before, during, or after treatment:*

I am pleased with my healing treatment following appointment:*

I feel the treatment provided was valuable and worth the cost:*

Would you recommend Venice Beach Surgical Center to others who are seeking medical care?*

Please offer any additional comments or suggestions to help us improve our service to you.

My comments provided on this form may be used in literature by Venice Beach Surgical Center*