Patient Feedback Form - Edmonton West Primary Care Network

Name

Phone Number

How would you rate the services provided to you by the EWPCN?

EWPCN clinician that provided services:

Comments

Disclaimer: By submitting this form, I agree that I will NOT include personal health information or seek health or medical advice. I understand that the Edmonton West PCN will NOT respond to personal health information inquiries. I understand the information I submit may be shared between Edmonton West PCN staff members to ensure the matter is resolved.

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