Patient Feedback

We value your opinion! Please complete the below form to give us your feedback.
 

Date of visit:

Clinic location: (*Mandatory Field)

Clinic was easy to find:
YESNO

Front office staff were professional and courteous:
YESNO

Wait time was acceptable:
YESNO

Technologist was courteous, attentive and procedure was explained to me:
YESNO

Feedback and suggestions:

__________________________

Please share your contact information so we can investigate and respond to your email. Thank you

Your Name: (*Mandatory)

Your Email: (*Mandatory)

Your Phone: (optional)

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