Employer Feedback U.S. HealthWorks takes pride in its contributory role toward successfully accomplishing your risk management goals. Your comments and suggestions are appreciated in our efforts to continuously evaluate and improve our level of service. Thank you for your time and feedback.

	Select Medical Center State	Select a State Alaska Arizona California Florida Georgia Illinois Indiana Maine Minnesota New Jersey North Carolina Ohio Pennsylvania Tennessee Texas Washington Wisconsin
	Select Medical Center
	How would you rate our overall service?	Please make a selection Excellent Good Fair Poor No Opinion
	Are we responding to your needs?

	Are you receiving a call from the treating physician after each initial visit?	Please make a selection Yes No
	Are Drug Screen results being reported to you as requested?	Please make a selection Yes No
	Are Physical results being reported to you as requested?	Please make a selection Yes No
	Are your employees satisfied with the treatment they receive?	Please make a selection Yes No
	Is the average wait time for your employees acceptable?	Please make a selection Yes No
	Is our staff courteous?	Please make a selection Yes No
	Is our staff helpful?	Please make a selection Yes No
	Would you like to tour our clinic and meet our medical director and staff?	Please make a selection Yes No
	Are there any billing issues that need to be resolved?	Please make a selection Yes No

	What educational seminars would you find helpful? Please be specific.
	How can we improve our service to you?
	It is not a required field to provide your contact information but we can better address any issues you may have if we can discuss those issues with you. Please consider providing your contact info. Thank you!
	Name:
	Company Name:
	Phone:
	Email Address: