Birth Center
Medical Center
About
Resources
Connect
Scheduling - Portal Access
Back
Birth Center Services
Birth Center Tour
Meet The Midwives
Birthing Classes
Back
Services + Procedures
Mobile Medicine
Meet the Team
Back
FAQs
Philosophy + Mission
Testimonials
Community Partnerships
Back
Patient Portal
Billing + Insurance
Forms
Shop Medicinary
Back
Contact
Seminars + Classes
Latest News
Birth Center
Birth Center Services
Birth Center Tour
Meet The Midwives
Birthing Classes
Medical Center
Services + Procedures
Mobile Medicine
Meet the Team
About
FAQs
Philosophy + Mission
Testimonials
Community Partnerships
Resources
Patient Portal
Billing + Insurance
Forms
Shop Medicinary
Connect
Contact
Seminars + Classes
Latest News
Scheduling - Portal Access
Patient Satisfaction Survey
Name
*
First Name
Last Name
Email
*
How young are you?
18-24
25-34
35-44
45-54
55-64
65 or above
Prefer not to answer
We have a fun referral program!* Who told you about our clinic?
*email info@canyonmedcenter.com for more info
Would you recommend Canyon Medical Center to a family member or friend?
Absolutely Not
Nope
Maybe
Yes, Indeed
Absolutely!
Regardless of your answer, why?
What do you love about us? What could we do better?
Who did you see at your visit?
(please check all applicable names)
Dr. Stephanie Auerbach
Dr. Rita Bettenburg
Dr. Seth Burrell
Dr. Karen DeWitt
Dr. Nadia English-Williams
Dr. Leslie Hamlett
Dr. Vanessa Lyon
Dr. Todd Pendell
Katerina Pozzi Baratta, LAc, MSOM
Blood Draw/IV-Brittany
Blood Draw/IV-Theresa
Financial Consult-Jessica
Other-please mention below
If other, mention here:
What is your rating of the interaction with your provider today?
★
★★
★★★
★★★★
★★★★★
If applicable, did your physician clearly explain your treatment plan, suggest follow up and provide easy to understand information?
I have no idea what to do going forward
It's a bit vague-I think I need clarification
I'm indifferent
I believe so!
I know exactly how to proceed
Did your physician listen and address your concerns?
Not at all
The verdict is still out
Totally neutral
Yes, Indeed
110%
How much confidence do you have in your physician's ability or competence?
None whatsoever
Some
I feel neutral
A pretty good amount
A TON! They're AMAZING!!!
What is your overall rating of your experience at CMC?
★
★★
★★★
★★★★
★★★★★
What was your overall impression of the clinic staff?
★
★★
★★★
★★★★
★★★★★
Anyone in particular you would like to mention?
Why?
They are a ray of sunshine
They rained on my parade
They silver lined the heck outta my day
They threw salt on my wound (proverbially speaking)
I feel like I am cozied up in a Sunggie® after interacting with them
That interaction made my blood boil
Please feel free to explain further:
On a scale of 1-5 stars, with 1 being the lowest, how do you feel about going to the doctor?
★
★★
★★★
★★★★
★★★★★
Feel free to go into more detail:
Are you comfortable with us sharing any portion of your feedback on our website or for any other marketing or promotional materials?
(only your first name and first initial of last name will appear in testimonials, unless otherwise indicated)
Yes, please do
That's fine, but please publish anonymously
No, thank you
Anything else you would like to let us know about?
Thank you!
