Registration

Mercy Health Network e-focus group

Mercy Health Network would like to welcome you to our e-focus group. Focus groups have proven to be a great way to gather feedback about your visit to the doctor's office. And though traditionally they are held in-person, with the web we can conduct a shortened version of a focus group and collect your opinions over the Internet.

Over the next few months, we'll send you one of our ideas for improvement and ask you to give us feedback at your convenience. We promise to keep our questions short, to listen to what you say, and to maintain your confidentiality. You'll be helping us make your clinic experience better.

Please fill in the information below, if you would like to participate in our online e-focus group.

Required Information

Please select your clinic
Mercy Health Bethany

Mercy Health Canadian County

Mercy Health Edmond Memorial

Mercy Health Edmond Santa Fe

Mercy Health North May
Mercy Health Northwest Family
Mercy Health Northwest Expressway

First Name

Last Name

Middle Initial

Address

City

State

Zip

Email address

Optional information - Demographic

Gender
Male Female

Birth Year

Marital Status
Married Single

Number in household

Number of children in household

Ages of children (please select all that apply)

Optional information - e-newsletters

Mercy Health System of Oklahoma provides general health information in our healthE-newsletters.

Check the box if you would like to receive our healthE-NEWS.