Dear Valued Member:

MDVIP, Inc. and our affiliated physicians are committed to delivering personalized medical care in a manner that exceeds your expectations. If you received a voice message, please take a few minutes to give us your input by completing the confidential survey below. Your personal evaluation of your experience will assist us in our efforts to continually improve the services you receive.

Thank you for your time and for sharing your opinions.

1. Please provide us with your first and last name, and if possible, your MDVIP Member ID Number.

Please provide us with your first and last name, and if possible, your MDVIP Member ID Number. First Name
Last Name
MDVIP Member ID Number

2. Please provide us with a valid email address.

Please provide us with a valid email address.

3. What is the name of your MDVIP-affiliated physician?

What is the name of your MDVIP-affiliated physician? First Name
Last Name

4. How would you rate each of the following:

	Poor	Fair	Good	Very Good	Excellent
Your overall experience as a patient in an MDVIP-affiliated practice?	How would you rate each of the following: Your overall experience as a patient in an MDVIP-affiliated practice? Poor	Fair	Good	Very Good	Excellent
Your overall relationship with your MDVIP-affiliated physician?	Your overall relationship with your MDVIP-affiliated physician? Poor	Fair	Good	Very Good	Excellent

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