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Dr. Samuel R. Swainhart
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480-488-7010
Patient Survey
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Patient Survey
Patient Survey
samswain2193
2016-07-30T22:08:14-07:00
Please help us improve our practice by answering the questions below. We truly appreciate your participation.
1. How would you rate your recent visit with us?
*
Exceptional
Pleasant
Somewhat pleasant
Unpleasant
2. Were all office members friendly, courteous, and respectful?
*
Exceptional
Very
Somewhat
Not Very
3. Was the office environment inviting, clean, and comfortable?
*
Exceptional
Very
Somewhat
Not very
4. Would you recommend our services?
*
Definitely
Very likely
Somewhat likely
Unlikely
5. Optional: Please leave any comments to let us know how we are doing or how we might improve.
Optional: Your name
First
Last
Optional: Please have Dr. Swainhart contact me regarding my recent visit.
Yes, pease contact me.
No, I have no issues to discuss.
Phone number
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