Parkview Medical Clinic Survey
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1. Survey
*
1
. Please fill our Demographic information:
Your Age:
Your Sex:
Provider name for today's visit
Please Complete:
0-18
19-25
26-35
36-45
46-55
56-64
Above 65
Please fill our Demographic information: Please Complete: Your Age:
Male
Female
Your Sex:
John Berg MD
Carl Burkland MD
Mark Berg MD
Daniel Berg MD
Michael O’Rourke MD
Jean Craig MD
Heather Hamernick MD
Provider name for today's visit
25%
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