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* 1. Can you please tell us the nature of your appointment?

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* 2. When did you attend your appointment?

Date

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* 3. Were you seen at your stated appointment time?

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* 4. If no how long was the delay in your appointment time from the scheduled time?

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* 5. How would you rate the quality of the consultation you received?

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* 6. Were you offered a choice of location and time for your appointment?

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* 7. How likely are you to recommend HealthHarmonie to friends and family if they needed similar care or treatment ?

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* 8. Please provide any additional comments

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* 9. Email Address

By completing this box you are giving consent for the feedback to be uploaded to HealthHarmonie's NHS Choices Page

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* 10. Name

If you wish to remain anonymous, please leave blank

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