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* 1. What is your age?

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* 2. Which practitioner treated you during your visit?

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* 3. Our Facility 

  Excellent Very Good Good Fair Poor
Hours of Operation Convenient for you
Overall comfort
Adequate parking
Signage and directions easy to follow 

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* 4. Your Overall Satisfaction with

  Excellent Very Good Good Fair Poor
Our Practice
The quality of your medical care
Overall rating of care from your provider or nurse

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* 5. Would you return to see this physician/practitioner for further care?

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* 6. Did any specific staff member stand out to you?

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* 7. Overall, how would you rate the service you received from the staff at our office?

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