Calian’s Veteran Care Pilot

Date

First Name

Last Name

This program made finding a primary care provider easier for me.

I am satisfied with the overall service I received connecting with a physician through the program.

How would you rate your experience from the time of intake into the program to booking the first appointment with the doctor (please check one)?

Scale: 1 - hard, 5 – easy

How likely are you to recommend this program to other Veterans?

Scale: 1 - hard, 5 – easy

If you were not able to access the program, what would you have done (check all that apply)?

If you selected Other, please elaborate:

I know who to contact if I have questions or concerns about this program.

Yes

No

Additional Comments

We value your feedback and strive to improve our program. Can we contact you to discuss your additional comments in question 7?

Yes – by email

Yes – by phone

No

Patient Experience Survey