Customer Satisfaction Survey
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Tell Us About Yourself

Mercy Medical Center—Des Moines would like to thank you for taking the time to helps us in our journey toward excellence, every day in every way.

Your comments and suggestions will help us continuously improve to meet your needs.

1. Please tell us a little bit about you. (Optional)

Please tell us a little bit about you. (Optional) Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. I am responding as a:

I am responding as a: Visitor

Patient

Other (please specify)

3. If you provided contact information above, may we contact you regarding your survey responses?

If you provided contact information above, may we contact you regarding your survey responses? Yes

4. What is your preferred method of contact?

What is your preferred method of contact? Telephone

Postal mail

E-mail

Customer Satisfaction SurveyCancel this survey >>

Tell Us About Yourself

Customer Satisfaction Survey
Cancel this survey >>