AAC - Customer Satisfaction Form

Let us know how we are doing:
How would you rate the cleanliness of our clinic?

Very Good Good Moderate Poor Very Poor
How easy was it to schedule a convenient appointment?

Very Easy Easy Moderate Difficult Very Difficult
How would you rate your overall experience?

Very Good Good Moderate Poor Very Poor
Please let us know how you found us?

Internet Friend Yellow Pages Other
Do you have any further comments or suggestions?
Should be Empty:

Let us know how we are doing: