Patient Survey

Our goal is to make you well! Please provide feedback to let us know what’s working, and where we can improve.

This form goes directly to our CEO, Harold Wallace. Please share your feedback so that we may make every visit to Marin City Health & Wellness Center, the Bayview Clinic and the Marin Family Birth Center the absolute best it can be.

Patient Survey

Please provide confidential feedback to our CEO about your patient experience.

I'd like to give feedback for:*
- Compliment
- Complaint
- Question
What would you like us to know?*
We care. How would you like us to respond?
May we contact you to learn more?
- Yes
- No
Your name and preferred contact (entirely optional)

We value ALL feedback. Your contact information will only be used by our CEO so that she may respond personally to your comments.
Date of your visit
MM slash DD slash YYYY
Name of our staff member

Please let us know the name of the staff or provider who served you so that we may share your confidential feedback.

Making an appointment is quick and easy! (415) 339-8813

Patient Survey