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Customer Service Survey 


1. Select the date of your office visit:
 
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2. Time of your office visit:
 



3. Purpose of your office visit:

Character limit 250

4. Did you receive the information requested?
 
If no, why? Character limit 100 

5. Was the staff courteous?
 

6. Was service provided in a timely manner?
 
If no, why? Character limit 100 

7.  Please rate your overall service:
 

8. My suggestion for improvement is (please describe): 
Character limit 250
-----------------------------------------  Thank you for completing the survey!  ------------------------------------------------
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