Share Your Story

Our organization is fortunate to receive frequent letters and phone calls from patients who want to share an exceptional experience they've had with a staff member or provider at a Mosaic Medical clinic.

If you have a story about how Mosaic Medical has impacted your life, the life of someone you know, or just want to offer kudos for a staff member or provider, you can submit your thoughts using the form below.

Your submission will be anonymous if you type "Anonymous" in the required First Name field. With your permission, we may share it with others by posting on our website or on our Facebook page.

 
First Name *
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Enter your first name here or type "Anonymous." Your last name will not be shared if your story is published.
Last Name
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Enter your last name here. Your last name will not be shared if your story is published.
Your Mosaic Medical Clinic *


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Select the Mosaic Medical clinic at which you receive your primary health care services.
Your Story *
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Type your story here.
A "Yes" response to the question, "Can we share your story?", permits Mosaic Medical to share your story while protecting your identity on its website, Facebook, and through any other marketing medium. A "No" response permits Mosaic Medical to share your story only with its own staff and providers.
Can We Share Your Story? *
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Please select "Yes" or "No" in response to the question.

Answering "Yes" to the question, "May we contact you?", encourages Mosaic Medical to contact you with opportunities to speak publically about your health care experience. If you respond "No", Mosaic Medical will not contact you with opportunities to speak publically about your health care experience.
May We Contact You? *
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Please select "Yes" or "No."
E-mail Address
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Enter your e-mail address here.

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