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* 1. How would you rate the overall quality of care you received?

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* 2. How satisfied were you with the wait time before seeing the doctor?

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* 3. How would you rate the professionalism and friendliness of the staff?

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* 4. Was the doctor able to address all your concerns and questions?

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* 5. How would you rate the cleanliness of our facility?

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* 6. How likely are you to recommend our practice to a friend or family member?

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* 7. Do you have any additional comments or suggestions for us?

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* 8. Please provide your name (optional):

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