Feedback Form

Name*

City*

Reason For Your Treatment*

How long was the wait before your appointment?*

Our service was delivered in a kind, calming, and caring manner:*

How would you describe the treatment you received at Oceanview Medical & Surgical Group?*

Dr. Augusto Rojas and his staff are readily available to me when I have questions before, during, or after treatment:*

I am pleased with my healing treatment following appointment:*

I feel the treatment provided was valuable and worth the cost:*

Would you recommend Oceanview Medical & Surgical Group to others who are seeking medical care?*

Please offer any additional comments or suggestions to help us improve our service to you.

My comments provided on this form may be used in literature by Oceanview Medical & Surgical Group*