Patient Feedback Survey

Thank you for visiting COLFS Medical Clinic. Your feedback helps us improve our services.

First name

Last name

Are you a new patient?

Yes

No

How long have you been a patient of this provider?

What was your wait time before the clinical staff brought you to an exam room?

Please enter the approximate wait time in minutes

How did you hear about COLFS Medical Clinic?

Please provide any additional feedback you have regarding our practice

Primary Care