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Customer Satisfaction Survey

Please rate the services you received while at the center. Choose the appropriate response or fill in the text box if appropriate.

	Location:
	What services did you use during your last visit?
	If other, please describe here:

	How did we do in providing the information / services you needed?
	Were we courteous?
	Were we helpful?
	Were we knowledgeable?
	How long did you wait before receiving services?
	Was the waiting time acceptable?

	Please rate the following
	Getting an appointment
	Your understanding of the treatment / instructions you received
	Your understanding of billing policies and procedures

	Are you satisfied with the hours of operation?
	If no, what additional hours would be helpful?

	How likely is it that you will return to the Center?
	What suggestions do you have to improve the Center?
	Why did you come to the Center?
	Was the Center easy to find?

	What mode of transportation did you use?
	Is transportation a problem for you?
	Is the location of the Center convenient for you?
	Were the facilities physically accessible?

	Were the services easy to use?
	How did you learn about the Center?