Patient Testimonial

Patient Name

Date of Visit

Test Provided
EEGERP

1. How would you rate your overall experience with our healthcare services?

Please select a rating.

2. How did our staff make you feel during your visit?
Cared forRespectedComfortableOther

3. Was there a specific staff member who made a positive impact on your experience? If so, please share how.

4. Is there anything else you’d like to share about your experience, our service, or any ways we can improve?

5. Do you give us permission to share your testimonial publicly (e.g., website, social media, marketing materials)?
Yes, I give my permission.No, please keep my feedback private.