Feedback Resolution Form

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Christmas Day hours: All locations closed.

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Thank you for taking the time to report your experience at AppleCare Urgent Care. We're committed to addressing your concerns timely and effectively. Please provide details about your visit, including date (if you have it) and the issue faced, so we can assist you promptly. A staff member will be in touch to resolve the matter.

Name*
First Last
Phone Number*
Email*
Did you visit one of our clinics?*
- Yes
- No
Date of Visit (mm/dd/yyyy)
MM slash DD slash YYYY
Location
Patient Date of Birth (mm/dd/yyyy)
MM slash DD slash YYYY
How was your experience?
Comments*
Email
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