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* 1. What is the name of the company in which you received services from?

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* 2. What was the name of the worker in which you received this service or visit from?

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* 3. What changes would most improve your experience?

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* 4. On a scale of 1-10, how likely are you to refer someone to the company in which you received service from?

0 10
i We adjusted the number you entered based on the slider’s scale.

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* 5. Do you have any other comments, questions, or concerns?

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* 6. Overall, how satisfied or dissatisfied are you with our company?

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* 7. What is something that you appreciated or enjoyed in result of a service or experience from this company?

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