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* 1. Overall, how satisfied or dissatisfied are you with Michelle Gossett?

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* 2. Overall, on a scale of 0-10 (0 being the lowest and 10 being most satisfied) how satisfied have you been with Michelle Gossett?

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* 3. What does Michelle do really well?

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* 4. What clinical areas or types of treatment do you perceive Michelle to specialize in?

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* 5. What changes would Michelle have to make for you to give it a higher rating?

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* 6. Which of the following words would you use to describe our services? Select all that apply.

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* 7. How well do our services meet your needs?

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* 8. How would you rate the quality of our services?

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* 9. How responsive have we been to your questions or concerns about our services?

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* 10. How long have you been a customer of Michelle Gossett?

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* 11. What is your typical frequency of visits or use of services?

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* 12. What type of services have you used? Select all that apply.

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* 13. How likely are you to use our service again in the future?

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* 14. How likely is it that you would recommend Michelle to a friend or colleague?

Not at all likely
Extremely likely

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* 15. What prompted you to seek services at the time that you did?

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* 16. What factors prompted you to select Michelle as your service provider?

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* 17. Would you like to provide an anonymous written testimonial?  If so, please do so below.  Some questions to think through:
~Please describe in as great detail as possible what has been your experience so far of Michelle and what she does really well.
~What have you learned/nor learned or deepened in your work together?
~How would you explain what is the same and also unique about Michelle with other providers and services?

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* 18. What is your gender?

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* 19. What is your age?

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* 20. Do you have any other comments, questions, or concerns?

T