Contact Form Fields marked with an * are requiredName*Phone*Email* Are you a new patient?*YesNoHow Did You Hear About Us?*How Did You Hear About Us?Online - GoogleOnline - FacebookReferralFamily / FriendOther I am interested in membership. Please contact me soon! MessageWhat is thirteen minus 6?* Patient Survey Have you had experience with a Direct Primary Care doctor prior to BSFM?*YesNoDo you have health insurance?*YesNoAre you a new or existing patient?*New patientExisting patientPlease rate our communication with you.*ExcellentGoodFairPoorPlease rate the overall comfort of our facility.*ExcellentGoodFairPoorPlease indicate your overall satisfaction with our facility.*ExcellentGoodFairPoorPlease rate the quality of medical care you recieved.*ExcellentGoodFairPoorHow Did You Hear About Us?*Online - GoogleOnline - FacebookReferralFamily / FriendOtherWhat would you like to see us develop in the future?What can we improve? I would like someone from Blue Skies Family Medicine to follow up with me regarding my comments. If yes, please provide contact information.