Patient survey form Book an appointment Patient Survey Form Your feedback is very important to us. We want to provide each patient with optimum care. Please take some time to complete this short survey so we know that we are doing good or if we can do better in the future. Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of visitDateTimeI was able to book an appointment at a time convenient to me.YESNON/AI received clear instructions to prepare for the exam.YESNON/AI was taken in promptly for my exam.YESNON/AThe technologist gave me instructions in a way which was easy for me to understand.YESNON/AThe clinic appeared clean and well-organized.YESNON/AI will definitely be returning to the clinic for another exam in the future.YESNON/AI will recommend the clinic to others who want high-quality exams.YESNON/AAny additional feedback/commentsSubmit