Patient’s Feedback Purpose of your Visit —Please choose an option—Immigration ExamInternal Medicine Date of Treatment Cannot remember the Date of Treatment Check this box if you cannot remember the Date of Treatment Patient First Name Patient Last Name Patient Email Preferred name for display Location —Please choose an option—BloomingdaleDes Plaines Permission for others to read review I allow other people permission to read my review How was your Provider? How was our Facility? How was your Wait Time? How was our Staff at North West Medical Care? How easy was it to get an appointment at North West Medical Care? How was your overall Experience? Tell us about your experience, what you liked, and what you would like to see different Terms and Conditions I agree to terms and conditions described below Terms and Conditions I acknowledge that the statements made in my testimonial are true and accurate. I certify that the opinions expressed in my testimonial or review are mine and mine alone. I understand that submitting fake or even false reviews about products or services is illegal. I verify that I have received care from this healthcare facility or provider. I verify that I was not paid to leave this review or testimonial. By submitting this review, I understand that my review or testimonial will be stored securely for reference. By submitting this review, I am fully aware and give explicit permission for my authentic testimonial or review to be posted on my behalf and for any marketing, sales, and advertising purposes or promotions. We will not share or sell your personal information including email except for the explicit purpose of review posting for display on websites mentioned above or similar sites. Please enter your initials to verify your identity