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* 1. Which of these would you rate highest as an upcoming prize for our quarterly referral giveaway? (Pinecrestdds.com/giveaways)

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* 2. Which of these would you rate 2nd highest as an upcoming prize for our quarterly referral giveaway? (Pinecrestdds.com/giveaways)

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* 3. Which of these would you rate 3rd highest as an upcoming prize for our quarterly referral giveaway? (Pinecrestdds.com/giveaways)

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* 4. In the past or present, which of these are the MOST IMPORTANT reasons as to why you’ve avoided or put off regular dental care? (Check all that apply)

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* 5. Since you’ve been a patient at Pinecrest Dental, how have we helped you the MOST regarding your dental health? (Check all that apply)

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* 6. How would you rate the service at our office? (check all that apply)

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* 7. What do you feel would be the most valuable referral offer for your friends, family or coworkers when they become a new guest at our practice? (Check all that apply)

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* 8. Your name (required to receive the $5 Dental Dollars credit) - your answers will be kept confidential!

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