* 1. Name/Date of appoinment?

* 2. Cleanliness of office?

* 3. Friendliness of staff?

* 4. Knowledge / Helpfulness of staff?

* 5. Efficiency of appointment?

* 6. Price of products and services?

* 7. Quality of products and services?

* 8. Ease of ordering?

* 9. Overall experience?

* 10. Comments / Suggestions?

T