We would like to ask you about your experience regarding your last visit to our office. Thank you for helping us continue to improve the care we provide for our patients.

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* 1. Overall, how satisfied were you with your last visit to our office?

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* 2. Overall, how would you rate the service you received at the reception area of our office?

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* 3. Did your appointment with your provider start early, late or on time?

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* 4. How well did your provider listen to your needs?

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* 5. How well did your provider explain your treatment options?

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* 6. How well did your provider explain your follow-up care?

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* 7. How likely is it that you would recommend your provider to a friend or family member?

Not at all likely
Extremely likely

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* 8. How satisfied are you with the cleanliness and appearance of our facility?

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* 9. Is there anything we could have done to improve your last visit?

T