Javascript is required to load this page.
Page Loaded
Tell us how we are doing. Thank you for taking time to share about your recent experience at the Health Center.
Contact Information (Optional):
Name:
Phone number
Email
Date:
Time:
Health Services area you are commenting on:
Director's Office
Administrative Services (Check-in/ Appointment scheduling)
Family PACT (Eligibility Intake)
Case Management- Nursing (Referral Assistance)
Medical Records (request for health records)
Nursing
Nursing (Immunizations/Screening)
Provider (Physician/Nurse Practitioner)
Lab
Pharmacy
Physical Rehabilitation Services
Triage (Walk-in Nurse)
TitanWell (Health Educator)
X-ray
Optometry
Confidential Advocate
Name of the staff member(s), if known:
Please rate the service you received at the area above today:
Excellent
Good
Fair
Poor
Your comments and /or suggestions:
I would like to receive a response:
No
Yes
Powered by Qualtrics