Please describe your experience visiting our practice.
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Please describe your experience working with the doctor(s) and staff.
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What was your favorite thing about being at our practice?
What areas could we improve upon to make your experience even more enjoyable?
How would you rate your overall experience?
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Poor
Average
Good
Great!
Please provide any additional comments/suggestions.
Would you like a member of our team to contact you to further discuss your experience?
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Yes
No thank you; See you at my next appointment
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