Give Feedback on a Healthcare Provider
Did you have a great experience with a healthcare provider you found through Garden State Equality's Affirming Healthcare Map? Did you have a difficult experience? Let us know using this feedback form.
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Name of healthcare facility
If your healthcare provider is an individual practitioner, you can leave this field blank.
Name of healthcare provider
How would you rate your experience on a scale of 1 to 5?
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Why did you give this rating?
Is there anything else you'd like to share about your experience with this healthcare provider?
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