Medical Mission Feedback Form
Please share your experience and feedback about your recent medical mission. Your input helps us improve future missions. All questions are general and do not request sensitive medical information.
Your Name
First Name
Last Name
Role During the Mission
*
Please Select
Physician
Nurse
Volunteer
Logistics/Support Staff
Other
Mission Location
*
Date of Mission
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate your overall experience?
*
1
2
3
4
5
What was the most positive aspect of your experience?
What areas could be improved?
How would you rate the organization and communication?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How would you rate the facilities and resources provided?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Any additional comments or suggestions?
Submit Feedback
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