Your feedback is very important to us! It will help us to ensure that we deliver
our very best healthcare experience for you at every visit.
This survey should only take a few minutes to complete. Only one survey needs to be completed if more
than one patient was served during the same visit.
Please refer to your Patient Visit Receipt, received at the end of your visit (pictured below). Enter
your Visit # and Date of Birth in the spaces to the right.
Your responses will remain confidential in compliance with HIPAA privacy regulations. Your participation
will not result in any marketing to you of any kind.