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* 1. Which Doctor did you see?

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* 2. Was your appointment 'face-to-face' or over Skype/phone?

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* 3. Which site did you visit?

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* 4. Was this your first visit?

How would you rate the following?

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* 5. Ease in getting through to us by phone.

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* 6. Courtesy of staff taking your call.

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* 7. Was there a long wait between making your appointment and when you could see the doctor?

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* 8. The waiting room and amenities were clean and presented well.

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* 9. How long did you have to wait to see the doctor?

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* 10. Doctor's personal manner (courtesy, respect, sensitivity).

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* 11. Doctor's instruction regarding care and treatment.

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* 12. Enough time and comfort to ask questions.

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* 13. Likelihood that you would recommend us to a friend or relative, should they require our services:

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* 14. How did you hear about us?

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* 15. Did you visit our website to gain further information?

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* 16. If yes, before or after consultation?

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* 17. From time to time we contact our patients to discuss their experience with us. Do you mind if we contact you?

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* 18. Which category below includes your age?

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* 19. Any comments?

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* 20. Please enter your email address if you would like to be added to our mailing list.

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