EXITSURVEY

EXIT
SURVEY

* Indicates required field

FIRST NAME *

USERNAME / NICKNAME *

Email *

FORMER MEMBERSHIP TIER *

TRIAGE ER OR ICU

PLEASE TELL US WHY YOU HAVE DECIDED NOT TO RENEW YOUR MEMBERSHIP? *

IN AS LITTLE OR AS MANY WORDS AS YOU LIKE. THIS WILL HELP US IN FUTURE TO ENSURE PATIENT SATISFACTION.

SUBMIT MY SURVEY