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* 1. How satisfied are you with Pinecrest Dental?

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* 2. I feel Pinecrest Dental always delivers on what they promise.

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* 3. Pinecrest Dental treats me fairly and respectfully.

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* 4. How likely is it that you would recommend Pinecrest Dental to a friend or colleague?

Not at all likely
Extremely likely

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* 5. If a problem arises, I can always count on Pinecrest Dental to reach a fair resolution.

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* 6. Which of the following words would you use to describe our services? (Select all that apply.)

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* 7. For our next charity, which organization would you prefer we make a donation to on your behalf?

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* 8. What is your preferred day of the week for appointments? (Check 1 or 2 of your preferred day boxes)

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* 9. What is your preferred time of day for appointments?

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* 10. Any comments (optional-confidential)

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* 11. Your name (optional and confidential).

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