top of page

Patient Evaluation Form

We’d love to hear how your appointment went! When we get feedback from patients, it allows us to develop our clinic into a better practice. Fill out the form below to tell us how we did. 

​

Please fill out the following form after your appointment.

Did the staff seem knowledgeable, treat you with respect, and protect your privacy?
Yes
No
Would you recommend WeARE to a friend?
Yes
No
Were you satisfied with the length of time spent with the provider?
Yes
No
Did the hours of the clinic work well for you?
Yes
No
If you answered “no” above, what hours would have worked better for you?
bottom of page