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Search
About Us
Careers
Join Us
Our Team
Aptiva Now
Conditions Treated
Departments
Imaging
Immediate Injury Care
Mental Wellness
Orthopedics
Pain Management
Physical Therapy
Spine
Sports Medicine
Wellness
Locations
Concussion & Sports Medicine Institute
Elizabethtown
Louisville - Central
Louisville - Downtown
Louisville - East
Louisville - Middletown
Lexington
Lexington Imaging Center
Lexington Physical Therapy
Mental Wellness
Northern Kentucky
Videos
Referring Providers
Imaging Portal
Records Portal
Refer A Patient
Services
Contact
New Patient Paperwork
Pay Bill
Patient Experience Survey
Date
MM
DD
YYYY
How would you rate your overall experience at Aptiva Health? Scale of 1 to 5 with 1 being the lowest and 5 being the highest.
1
2
3
4
5
Would you recommend a friend or family member to treat at Aptiva Health? Scale of 1 to 5. 1 would not recommend and 5 is highest recommendation.
1
2
3
4
5
How would you rate the likelihood that you would treat at Aptiva Health for future healthcare needs? Scale of 1 to 5. 1 unlikely and 5 highly likely to treat again:
1
2
3
4
5
Would you be willing to provide us a review or testimonial?
*
Yes
No
If so, what would you provide?
Photo
Video
Quote Only
Do you have any additional feedback or comments you would like to provide?
*
Name
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Thank you!
