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Tell Us About Your Company

Thank you for taking the time to fill out this form. The information gathered from this form helps us learn a little more about your company and how we can better serve you.


Company Name:  *Address: City, State, Zip: Phone Number:  *Your type of industry:  *Approx. number of employees: Are you a DOT registered company? Is Phoebe Corporate Health on your Worker's Comp Panel of Providers? Do you have a wellness plan for your employees? 
Our Clinic Performance (skip if you have not used our services)
5 4 3 2 1 (Option 5 = excellent or highly satisfied, Option 1 = poor or not satisfied)
Phoebe Corporate Health facility appearance and adequacy: 

Quality of care received at Phoebe Corporate Health: 

Customer service of Phoebe Corporate Health: 

Overall Satisfaction with Phoebe Corporate Health (skip if you have not used our services)

 Would you recommend us? If no, tell us why: How can we improve our clinic and services? 
What services would you like to know more about?

 Choose all that apply: 

How would you like to receive information about Phoebe Corporate Health? Have you seen our website? If yes, are we easy to find online? What do you like best about the website? What can we improve on the website?