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Patient Comment Card

Thank you for choosing McFarland Clinic. We pride ourselves on the quality of care and service offered by our professional staff. Our goal is to ensure that you have a positive and meaningful experience with everyone you come in contact with in our organization.

We welcome your comments and feedback. Please take a moment to share your thoughts regarding your visit with us. Your impressions will assist us in improving our services and recognizing individuals that provide outstanding care and service.

If you are a patient or family member who is concerned about the care you received, you may use the form below or call our Patient Relations department at 515-239-4467.

Your feedback is greatly appreciated. Thank you.

* Indicates a required field

Date of Visit:

Name of Department Visited:

City of McFarland Clinic Location:

Physician(s) or Provider(s) seen:

Were you satisfied with your visit at McFarland Clinic?:

Yes

What improvements can we make to better fulfill your health care needs?:

Is there a person or anything else about your experience that we should recognize for extraordinary care and service?:

Would you recommend McFarland Clinic to family and friends? Why or why not?:

Your Contact Information

Name:

E-mail:

A confirmation email will be sent to the address entered here.

Confirm E-mail:

This needs to match the value of the previous field.

Street Address:

City:

State/Territory:

May we call you for follow-up if necessary?:

Yes

Approval:

Yes, I approve sending this via email. I understand this message will not be encrypted. I also understand my medical information may be reviewed.