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We are sorry to see you go.
At Fairhope Pediatrics we strive to provide exemplary care for every patient. Can you please take a moment to let us know about your experience?
What is the patient's name and date of birth?
Name
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DOB
(Required)
MM slash DD slash YYYY
Please tell us why you are transferring to another pediatrician or other primary care provider.
(Required)
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My child has transitioned to an adult doctor
My insurance changed and you are no longer in network with my plan
I do not want to vaccinate my child according to CDC guidelines
I do not want to complete CHADIS questionnaires
Poor experience
Other
Please explain.
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Phone
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