Koasty Kids: Physicians in your new area...
Thank you so much for helping us help you by filling out this survey. Your answers are 100% anonymous, even to us. You can fill this survey out as many times as you like. We ask that you please fill out one survey per doctor so that the results may be filtered for more efficient searching. On behalf of Koasty Kids and all the USCG families that will benefit from your responses...Thanks again for helping us help you by filling out this survey!
Sign in to Google to save your progress. Learn more
State *
(State)
I was stationed in ... *
(city only)
Dr.'s Name *
Dr. 's first and last name
MD or DO *
(if you remember - some people have a preference, and most people don't notice)
Specialy *
(self explanatory we think - make sure to check all that apply)
Required
Rating *
(overall)
UGH! No bed side manners, super impatient, always late, horrible communication.
Great! I wish I can stay here bc I love this Dr. so much!
The good, the bad, and the ugly...
(remember- honest but objective)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report