2900-0876-V2 Scheduling an Appointment

VA Survey

OMB Number: 2900-0876
Expiration: 09/30/2023
Estimated Burden: 2 minutes

The VA provides free, confidential support 24/7 for Veterans and their family and
friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 2738255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you
are homeless
or at risk of homelessness, contact the National Call Center for
Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting
https://www.va.gov/HOMELESS/.

Help us serve you better
We want to hear about the health care appointment you made on August
19, 2019. By indicating how much you agree or disagree with the
statements below, you directly help us improve VA services.

This survey should take you approximately 2 minutes to complete.

It was easy to get my appointment.
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I got my appointment on a date and time that worked for me. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

https://survey.voice.va.gov/?va-outpatient-scheduling-appointment[8/19/2020 11:39:09 PM]

Agree

Strongly Agree

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1

2

3

4

5

When scheduling my appointment, I was treated with courtesy and respect.
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I am satisfied with the service I received from Atlanta VA Clinic. Required
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

During my most recent VA health care experience, I felt respected and comfortable.
Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

I trust Atlanta VA Clinic for my health care needs. Required
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VA Survey

Strongly Disagree

Disagree

Neither Agree nor
Disagree

Agree

Strongly Agree

1

2

3

4

5

Would you like to provide additional feedback with a concern, compliment, or
recommendation about your experience(s) with Atlanta VA Clinic? Please select from
one of the following options. Required
- Select your response -

Use the text box below to enter details of the additional feedback (optional). Please do
not include any personally identifiable information, Social Security Number, Veteran
ID, or medical information, but do provide details about your experience.

0 / 400

Can VA contact you about your feedback? Required
Yes, VA can contact me about my patient experience.
No, I do not want VA to contact me about my patient experience.

https://survey.voice.va.gov/?va-outpatient-scheduling-appointment[8/19/2020 11:39:09 PM]

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Would you like to volunteer your demographic information to help VA better serve
you?
Yes
No

Next
Next

We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. By filling out this survey,
you are authorizing VA database access to retrieve Veteran contact information to follow up with you accordingly for purposes of service
recovery, potential crisis, or to learn more about feedback you have shared regarding your experience with VA. VA may utilize individual
Veteran survey data from this survey or other sources to ensure the final scores truly and accurately represent the experiences of
Veterans. This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States
Code, allows us to ask for this information. We estimate that you will need an average of 2 minutes to review the instructions and complete
this survey. The results of this survey will be used to inform opportunities for program improvement in the quality of VA services.
Participation in this survey is voluntary, and your decision not to respond will have no impact on VA benefits or services which you may
currently be receiving. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are
not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the
OMB Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided by law.

Privacy Policy

https://survey.voice.va.gov/?va-outpatient-scheduling-appointment[8/19/2020 11:39:09 PM]