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* 1. Do you trust the staff?

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* 2. Do the staff listen to you?

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* 3. Would you recommend the staff?

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* 4. Were you looked after efficiently?

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* 5. How clean is where you were treated?

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* 6. Were you treated with dignity and respect?

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* 7. Were you looked after promptly?

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* 8. Were any fears or concerns adequately addressed?

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* 9. How well did the staff meet your needs?

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* 10. I am:

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* 11. Add your comments:

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* 12. If you have a specific issue or concern that you want us to provide direct feedback on, please write down your name and contact details below, and we will contact you as soon as possible.

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