Please fill out the below confidential survey. How would you rate the person who greeted you at our office today? N/A Unacceptable Poor Good Excellent How would you rate the general support staff experience at the centre today? N/A Unacceptable Poor Good Excellent How would you rate the physician who treated you today? N/A Unacceptable Poor Good Excellent How would you rate the wait time? N/A Unacceptable Poor Good Excellent How would you rate your pharmacy experience today? N/A Unacceptable Poor Good Excellent If there is anything you would like to tell us about your visit today, please enter it below? (OPTIONAL) May we share your comments on our web site? (We keep all patient names confidential.) Yes No If you would like for a member of our team to contact you regarding your visit today, please provide us with contact information in the space below: (OPTIONAL) Captcha Test 1 + 2 =
