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* 1. Please select Autumn Smile Dental office location.

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* 2. How courteous and friendly was the receptionist?

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* 3. Did the receptionist answer all your questions?

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* 4. How friendly was the dental assistant?

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* 5. How gentle was the dental assistant?

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* 6. How thorough was the hygienist?

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* 7. How gentle was the hygienist?

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* 8. How professional was your dentist?

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* 9. Overall, how would you rate your dentist's quality of work?

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* 10. Overall, how would you rate your experience at Autumn Smile Dental?

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* 11. How likely is it that you would recommend Autumn Smile Dental to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 12. What did you like best about this practice and its services?

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* 13. What did you dislike about this practice and its services?

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* 14. In what way could we improve your experience?

T