Overall, how satisfied were you with your visit?
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Extremely Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
If not satisfied, please tell us what we could have done to make your visit better.
Did you experience a long wait time?
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No, I got in right away
No, I waited a small amount of time
Yes, but I expected the wait
Yes, and I did not expect to wait that long
How courteous and professional was our staff?
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Extremely courteous and professional - they went out of their way to attend to me
Somewhat courteous and professional
Not at all - I was not treated with courtesy and respect
How likely are you to recommend us to others?
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Very Likely
Not Likely
Was everything explained to you in a way you could understand?
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Yes
Somewhat
Not At All
Any Additional Comments?
You may use my comments online as a testimonial of your services.
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Yes, of course!
No, please keep my comments private
E-mail
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Please do not disclose personal health information on this form. By completing and submitting this form, you consent to us communicating with you by email about this survey. Thank you.
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I Agree
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