* 1. Where you called and reminded of your appointment?

* 2. Did your appointment begin on time?

* 3. How helpful was the person at the front desk

* 4. How Easy is the check in?

* 5. Comments?

* 6. How comfortable is the waiting area?

* 7. How easy is it to find your way around?

* 8. How clean is our facility?

* 9. How friendly is the staff?

* 10. How well was your service explained?

* 11. How skilled is the staff?

* 12. How concerned is the staff for you?

* 13. Our concern for your privacy?

* 14. Our sensitivity to your needs?

* 15. Our response to your concerns?

* 16. Staff's overall concern for you?

* 17. Were you made to feel welcome?

* 18. Were you treated with dignity and respect?

* 19. Did the service meet your exspectations

* 20. How the staff worked together for you?

* 21. Overall rating of our services?

* 22. Would you recommend us to others?

* 23. Why or why not?

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