Patient's first name
Which State is the clinic you visited in?
Which Illinois Location did you visit?
Gage Park, Chicago
Mt. Greenwood, Chicago
River North, Chicago
Roscoe Village, Chicago
West Loop, Chicago
Wicker Park, Chicago
Which Indiana Location did you visit?
When did you visit our clinic?
Were you pleased with your overall experience at our clinic?
Was the Front Desk Staff polite and helpful?
How long was your overall wait time?
Less than 15 minutes
Longer than 60 minutes
Were you satisfied with your overall wait time?
Would you return for additional care if needed?
Would you recommend us to your family and friends?
Was your provider sensitive to your needs?
Do you feel your provider listened to you?
Who was your provider?
Suggestions on any services you would like us to offer.
Suggestions on how we can improve our services.
Any additional comments you would like to share with us.
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If you would like to be contacted regarding your experience, please list your contact info below.
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