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Feedback Form
The Oregon Clinic continuously strives to improve our service to accommodate the needs of our patients. Please tell us about your experience with our staff, physicians and/or web site. We welcome your comments and suggestions.
Are you a patient of The Oregon Clinic?
Yes
No
Former patient
Name
Phone number
E-mail address
How did you hear about us?
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Your Doctor
Online
Radio/Ad Publication
Billboard
Yellow Pages
Friend/Family member
OTHER
Comments
I understand this form is used for feedback related to my experience with The Oregon Clinic and is not intended to communicate health related information with my physician or physician's office.