Patient Feedback

In our effort to always improve the quality of our services, we would like to know about your recent experience at The Children's Medical Center. This form must be completed by the parent/guardian or patient over the age of 18. The information gathered in this form will only be used for quality improvement purposes.
  • Your experience before your visit...

    Please rate the following.
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  • Your experience during your visit...

    Please rate the following.
  • ExcellentGoodPoorDoes Not Apply
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  • ExcellentGoodPoorDoes Not Apply
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  • ExcellentGoodPoorDoes Not Apply
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  • Please include your name and email address so that we may contact you to learn more about your experience. Your responses will only be used for quality improvement purposes.