At Northwest Asthma & Allergy Center, we want to provide the best health care possible. To make this happen, we would appreciate your feedback about what we are doing right and what we could do better. Please take a few minutes to share your clinic experience with us. Your responses are confidential. A space is provided for you to also comment on specific issues (good or bad). We thank you in advance for your time and candid thoughts.
Date of visit: __________________ Physician: _______________
Using the scale below, please rate the services you received from our practice in the following areas.