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Your feedback helps us do better.

Please rate your satisfaction with the care provided during your visit?

How well did the healthcare providers communicate with you?

Please rate your satisfaction with the following aspects

	Very Poor	Poor	Average	Good	Excellent
Wait Time	Very Poor	Poor	Average	Good	Excellent
Staff Friendliness	Very Poor	Poor	Average	Good	Excellent
Cleanliness	Very Poor	Poor	Average	Good	Excellent
Clarity of Communication	Very Poor	Poor	Average	Good	Excellent

Are you satisfied with the follow-up care after your visit?

To what extent do you agree or disagree with the following statement? It was easy for me to schedule the appointment

How likely are you to recommend us to a friend or colleague?


0	1	2	3	4	5	6	7	8	9	10

Is there anything we can do to improve your satisfaction as a patient?

Thank you for your feedback.

Wishing you a good and healthy day ahead.