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Physician Communication Form

* Indicates required information

Please provide the following information to help us best serve you.

First Name
Last Name

1. *
Was this your first time using the Physician Communication Tool?
2. *
How satisfied were you with the Physician Communication Tool?
3. *
Do you feel the Physician Communication Tool is a good addition to other avenues of communication available to you?
Instruction What do you see as the benefits of the Physician Communication Form?
4. *
Easy access for physicians to identify issues and ideas for resolution
5. *
Getting physician concerns to the appropriate person?
6. *
More timely response than other means of communication?

2131 S. 17th Street, Wilmington, NC 28401  |  910.343.7000