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Name (optional)

Phone (optional)

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Which one of our clinics did you visit? (Please select from the drop-down.)

Were you greeted by the staff upon arrival?
YesNo

Did the staff answer any questions you may have had?
YesNo

Did you meet with the Office Manager?
YesNo

Did the doctor take the time to answer any questions you may have had?
YesNo

Did we explain the services that you needed in a way that was easy to understand?
YesNo

Did the office personnel treat you in a professional and kind manner?
YesNo

Was the reception area neat and clean?
YesNo

Were you satisfied with the quality of care provided to you?
YesNo