Show/Hide

The County of Santa Clara's Shelter-at-Home order remains in effect as some businesses and new activities are allowed to reopen with social distancing protocols and safety requirements in place. For local updates on the coronavirus (COVID-19) outbreak, visit SantaClaraCA.gov/CoronavirusUpdates.

Vaccination Clinic Customer Satisfaction Survey

Print
Press Enter to show all options, press Tab go to next option

Please correct the field(s) marked in red below:

1
I chose SVACA’s vaccine clinic because:
I chose SVACA’s vaccine clinic because:
2
Please rate your experience:
 *
Please rate your experience:
Strongly Agree Agree Somewhat Agree Disagree Strongly Disagree N/A
SVACA staff was courteous.
The wait time was reasonable for a low cost clinic.
I will recommend SVACA to my friends and family for vaccination services.
I will return to SVACA for future services.
3
Comments:
4
Your Name
5
Your Email
  1. To receive a copy of your submission, please fill out your email address below and submit.
    View Full Site