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At BVNS, we value your feedback and want to continually improve our services. Please complete this survey about your experience with us.

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* 1. What was the date of your visit?

Date

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* 2. Was this your first visit to BVNS?

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* 3. How did you find out about BVNS?

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* 4. Which location did you visit?

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* 5. What was the reason for your visit?

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* 6. Why did you choose BVNS?

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* 7. Please indicate your level of satisfaction with the following aspects of our service.

  Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Availability of appointments
Wait time prior to appointment
Customer service before your appointment
Quality care provided by medical staff
Clarity of communication
Time required for medical treatment
Post-service follow-up
Overall Experience

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* 8. Please complete the following sentence. Our service:

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* 9. Please feel free to provide comments/suggestions on our service.

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* 10. Please rate how comfortable you were with the post-appointment instructions you were provided.

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* 11. Please feel free to provide comments/suggestions on the post-appointment instructions you were provided:

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* 12. If you would like to comment on the performance of any individual group member please do so here.

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* 13. Please rate your overall experience with BVNS.

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