UMI Clinic Patient Survey
We would like to know how satisfied you are with the services you have received at UMI Community Imaging Clinic. Your feedback is very important to us. We appreciate you answering a few questions.
Sign in to Google to save your progress. Learn more
The staff explained the procedure well *
Strongly Disagree
Strongly Agree
I was comfortable during the procedure *
Strongly Disagree
Strongly Agree
Overall, I had a good experience having my procedure done at UMI Clinic *
Strongly Disagree
Strongly Agree
Comments and Feedback
*
Optional: Your Name
This question is optional.
Optional: Your Email
This information is optional.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of United Medical Institute.

Does this form look suspicious? Report