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QUCW

Page One

1. How would you rate your experience?

Space Cell	Unsatisfied	Needs Improvement	Happy with Service	Great Job
Cleanliness of the Facility
Wait Time
Interaction with Medical Staff
Interaction with Reception
Overall Experience

2. How likely are you to refer your friends and family to our practice? (Please explain)

Very Likely	Possibly	Not Likely

3. In your opinion, where can we improve?

4. We would love your feedback from your experience with us at Quality Urgent Care. *This question is required.

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