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* 1. What was the key reason(s) you chose our practice for your eye care needs? (Select All That Apply)

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* 2. When you called for an appointment, how satisfied were you with the response from the person who answered the telephone?

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* 3. When you arrived at the office, did you find the receptionist to be friendly, courteous, and helpful?

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* 4. Did any specific staff member help to make your visit more enjoyable?

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* 5. How acceptable was the amount of time spent in the reception area and examining, before seeing the doctor?

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* 6. During our examination, did you find the doctor to be friendly, courteous, competent, professional, and sympathetic/caring?

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* 7. Did you purchase glasses in our office?

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* 8. Please rate the courtesy and helpfulness of the employee who helped you with your eyeglasses:

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* 9. Overall, how satisfied or dissatisfied are you with Manzo Eye Care?

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* 10. How likely is it that you would recommend Manzo Eye Care to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

T