We would like to ask you about your experience regarding your last visit to our office. Thank you for helping us continue to improve the care we provide for our patients.

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* 1. What date was your visit to Grayson Family Care LLC?

Date

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* 2. Overall, how satisfied were you with your last visit to our office?

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* 3. Overall, how would you rate the service you received at the reception area of our office?

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* 4. Did your appointment with your provider start on time?

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* 5. How easy was it to obtain referrals, lab orders, imaging orders or prescription refills?

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* 6. How was your experience with phlebotomy / blood draw?

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* 7. How easy was it to make a follow up appointment?

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* 8. How satisfied are you with the cleanliness and appearance of our facility?

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* 9. How likely is it that you would recommend Grayson Family Care LLC to a friend or family member?

Not at all likely
Extremely likely

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* 10. (Optional) Would you like to provide your name and contact information?

T