Name Email Age group Under 18 18-24 25-34 35-44 45-54 55-64 65 or above Gender Male Female Prefer not to say Contact DOB How did you hear about us ? Internet Advertisement Friends Other Would you recommend our services to others ? Yes No Maybe Mention your Level of satisfaction from our services 1 (Very dissatisfied) 2 (Somewhat dissatisfied) 3 (Neutral) 4 (Somewhat satisfied) 5 Very satisfied Are these services expected to contribute positively to the improvement of your healthcare in the future? Yes No How was your experience at Yolo Health ATM ? Do share your photo and video responses. Feedback / Suggestions if any ? Submit