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1. Please rate the quality of the services you received from us:

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2. Please rate the information we provided on our website:

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3. Please rate our staff in terms of efficiency:

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4. Please rate our responsiveness to feedback:

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5. Please rate your overall experience with our services:

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6. Would you recommend us to friends and family?

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Reason:
Patient Name:
Office Visited:
Date of appointment:
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