Turned Away?

We're committed to understanding and improving our patients' experiences. If you were unable to receive care during your recent visit to AppleCare Urgent Care please share your feedback below. This will help us address any issues and enhance our services for future visits.

Name*
First Last
Phone Number*
Email*
Patient Date of Birth (mm/dd/yyyy)
MM slash DD slash YYYY
What was the reason for not being able to provide you with service today?*
- Insurance
- Billing/ Credit Card Issues
- Not Taking Walk-Ins
Date of Visit (mm/dd/yyyy)
MM slash DD slash YYYY
Location*
Comments*
Comments
This field is for validation purposes and should be left unchanged.