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Thu, 2011-10-13 14:40 -- Joel.Parriott

Instructions: Kindly complete this survey in order for your reimbursement to be processed for participating in the Communicating With Washington program. Thank you.

Personal Information Form
Your Visit
1=Bad & 5=Excellent
How many people did you visit?
1st Visit
1=Poorly & 5=Very Well
Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you.
2nd Visit
1=Poorly & 5=Very Well
Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you.
Overall Experience