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* 1. Your experience on the phone with us was helpful and effective.

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* 2. Were you greeted warmly and helped quickly after entering the building?

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* 3. Did the technician and doctor help you accordingly and answer all your questions?

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* 4. Your appointment was...

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* 5. Is our facility clean and inviting? What can we improve on?

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* 6. Please rank your overall experience from 1-5 (1 being the worst and 5 being the best)

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* 7. Any additional comments or concerns

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