Patient Generated Feedback

I was pleased with the care I received at Toiyabe? *

If no or not sure, please describe concerns.

Date of issue/concern *

mm/dd/yyyy

Department *

Name(s) of individuals involved?

I would like to see the following action taken: *

I would like follow-up by the Toiyabe Quality Team *

Your name (for follow-up)

Your phone number (for follow-up)

Your email (for follow-up)

*

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