Guest Exit Survey
Prescott Valley, 2025
Medical Records Number
Name
Phone Number
Please enter a valid phone number.
Address
Email
example@example.com
How long was your wait after registration before you were served?
30 mins
1 hour
2 hours
3 hours
4 hours
5 hours
6+ hours
Would you recommend us to a friend?
Yes
No
Why would you not recommend us?
Do you plan to return next year?
Yes
No
Why would you not return next year?
Comments / Feedback
Which programs below would you like more information on?
Abuse (All Types)
Addiction Recovery
Adult Family Dysfunction
Aging Gracefully
Anger Management
Anxiety Management
Cardiac Health
Codependency
Depression Recovery
Diabetes Reversal
Grief Recovery
Heart Healthy Cooking
Preventing & Treating Colds & Viruses at home
Relationship Seminar
Stop Smoking
Stress Management
Weight Loss
Bible Study
Woman' Bible Study
Financial Peace
Chaplains Initials
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