Primary Care Provider Feedback

Primary Care Provider Feedback Form

* Indicates required field

Name *

First

Last

How much time do you spend charting after each shift? (minutes) *

How would you rate your current on-the-job satisfaction while using a scribe? (10 being excellent, 1 being poor) *

How would you rate your overall experience with Clinical Scribes LLC? (10 being the best, 1 being the worst) *

How could we improve our services? *

Is it ok for Clinical Scribes LLC to use your comments for marketing purposes? *

If you answered yes to the question above, which identifier may we attach to your statements? *

First and Last Name Initials Either None of these options

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