Francis Holistic Medical Center Feedback


How are we doing?
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  Your Name:
  Patient Name (if different):
  Mailing Address:
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  Zip Code:
  Home Phone:
  Email Address:
  Patient Gender:
  Patient Age:
  *What service did you come in for with this visit?:
  *What time of day did you come in?:
  *How many times have you visited our center?:
  *Please rate the courtesy of our receptionist.:
  *How long was your wait for your appointment?:
  *Please rate the proficiency of the Nursing Staff.:
  *Would you recommend this facility to anyone?:
  If you would not recommend us, please state why.:
  *Please rate our website's design and ease of use.:
  *Please rate our instructions on lab kits/forms.:
  What problem(s) did you have with lab kits/forms?:
  What do you like most about our services?:
  Please list how our services could be improved.:
  Please share any additional comments.:

 
Copyright 2004   Francis Holistic Medical Center, P.C., Last Modified: March 12, 2008