Patient Survey

  • Date Format: MM slash DD slash YYYY
  • Rate Trinity's Performance

    One a scale of 1-5 (1 being below average and 5 being excellent), Please rate Trinity’s performance in the following areas: *
  • Please provide any other comments you would like to share about your Trinity experience:
    I grant permission for Trinity to use my comments for promotional purposes.
    Would you like a Trinity representative to follow-up with you regarding your experience?
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