Today's Date

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* 1. Today's Date

What services did you have today?

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* 2. What services did you have today?

Please rate the following:

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* 3. Please rate the following:

  Excellent Satisfactory Unsatisfactory
Staff answered my questions
Courtesy of staff
Quality of staff
Promptness of service
Overall satisfaction
How can we improve our services?

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* 4. How can we improve our services?

Do you have something that you would like to discuss with us?

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* 5. Do you have something that you would like to discuss with us?

Would you like to recognize a staff person for exceptional service?

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* 6. Would you like to recognize a staff person for exceptional service?

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