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Percentage of Improvement:
Current Pain Level
1
2
3
4
5
6
7
8
9
10
No Pain
Worst Pain Imaginable
1 is No Pain, 10 is Worst Pain Imaginable
Comments/Suggestions:
Survey of the Office
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Satisfied
Somewhat Satisfied
Not Satisfied
Treatment and Services Received
Explanation of condition and Treatment plan
Length of time spent with doctor
Treatment results
Promptness of Service
Friendliness and Concern of Doctors
Available and convenient appointmen times
Explanation of Insurance Benefits
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