Wardenburg Health Center

Date of Visit to Wardenburg: / / 20

Departments Visited (check all that apply):

• Medical Clinic
• Psychological Health Clinic
• Sports Medicine Clinic
• Women's Health Clinic
• Laboratory
• X-ray
• Business Office
• Community Health
• Insurance Office
• Records and Scheduling (Referrals, Release of Info, Appointment Scheduling)
• Other

Were you here for a scheduled appointment? YesNo

       If here for a scheduled appointment, were you seen on time? YesNo

Was our staff courteous and respectful? YesNo

Were we able to assist you with your concerns? YesNo

Comments:

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