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* 1. Name - *If you want to submit this form anonymously leave the name section blank.

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* 2. E-Mail - *If you want to submit this form anonymously leave the e-mail section blank.

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* 3. We would like you to think about your recent experiences of our service. How likely are you to recommend our practice to friends and family if they needed similar care or treatment?

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* 4. Do you have any other comments?

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* 5. How has your experience been when trying to get an appointment?

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* 6. The way our staff welcomed you?

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* 7. The way clinical staff listened to you?

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* 8. The way you were treated?

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* 9. Your time with us today?

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* 10. Do you have any other comments or suggestions on how we can improve?

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