Patient Survey

Patient Satisfaction Survey

The physician and staff of Michigan Avenue Primary Care strive to provide extraordinary care and value feedback. If you have been a patient and would like to complete our brief survey please fill out the form below.

Paitent Survey Submitted

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Date of Visit

Name or Initials

Please rate your overall experience in our office today *

The phone staff *

The front desk staff *

The medical assistant(s) or nurse(s) *

The doctor *

Please comment on any specific aspect of your experience with us today *

Would you return to Michigan Avenue Immediate Care and would you refer others? *

Yes

May we add your comments to the testimonial section of our website?

Yes

Testimonial Initials (ex: John D.)

Testimonial City/State (ex: Chicago, IL)