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We'd like your feedback! Please take 2 minutes to fill out our online
survey.

1. Have you ever downloaded online medical forms before?

YES NO

If yes, where did you obtain your forms?


2. On our website, which forms did you obtain? Check all that apply.

Medical History Form
Medication Refill Log
Allergy List
Pain Medication Log
Emergency Information
Headache Log
Blood Pressure Log
Blood Sugar Log
Insulin Injection Log
Seizure Log


3. Do you plan to share your completed medical forms with your physician, nurse or other healthcare provider?
YES NO

If no, why not?


 
4. Does your healthcare provider recommend using online medical forms to manage your medical profile?YES NO

 

5. Did you find our Medical Forms website easy to navigate? Please tell us of any difficulties you encountered.


 
6. Are there any additional medical logs or diaries would you like to see offered on our website? If yes, please tell us which forms.


FIRST NAME


LAST NAME

ADDRESS

City

State

Zip

EMAIL




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