Guest Exit Survey
Willcox, 2025
Medical Records Number
Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Email
example@example.com
How long was your wait after registration before you were served?
1 hour
2 hours
3 hours
4 hours
5 hours
6+ hours
What service did you find most benifical?
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?
Anxiety Management
Bible Prophecy Seminars
Diabetes Reversal
Grief Recovery
Health Class
Healthy Cooking
Hiking Club
On-on one Bible Studies
Photography Club
Preventing & Treating Colds and Viruses at Home
Spanish/English Language Classes
Stop Smoking
Stress Management
Strings Ensemble (for beginners on up)
Vacation Bible School
Weight Loss
Chaplains Initials
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