Use the form below to let us know how your last visit to ECMHCI went. Fields marked with * are required. Date of Visit: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Who did you see? * Your opinion is very important to us. Please mark "Yes" or "No" to the following questions:Did you have an appointment? Did you have an appointment? * Yes No Did you feel welcome? Did you feel welcome? * Yes No Were all the employees friendly and helpful? Were all the employees friendly and helpful? * Yes No Did we see you in a timely manner? Did we see you in a timely manner? * Yes No Did we explain everything clearly? Did we explain everything clearly? * Yes No Do you feel your Provider listened to you? Do you feel your Provider listened to you? * Yes No Were your problems handled to your satisfaction? Were your problems handled to your satisfaction * Yes No Do you feel we care about you? Do you feel we care about you? * Yes No Would you recommend this clinic to a friend? Would you recommend this clinic to a friend? * Yes No What did you like or not like? (If you answered No to any questions, please feel free to write your comments or suggestions here.) tellushowtoimprove Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
