Patient Experience at EPHC
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Email *
Name: *
Contact Phone Number: (you will not be contacted unless you request to be) *
May we share your comments within our organization and with the community? *
Would you like to be contacted in reference to your feedback? (Contact can be expected within 3 business days) *
What day and time did this experience occur? *
Which department did this experience occur? (i.e. ER, Portola Clinic, Billing, etc.) *
Share your experience with us: *
A copy of your responses will be emailed to the address you provided.
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