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Style 2

2014_survey_form

 

 

 

 

 

    1) How would you rate the availability of Miami Center for Dermatology?: *
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    2) Overall how satisfied were you with your provider?: *
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    3) How satisfied were you with the courtesy of the staff?: *
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    4)Would you recommend Miami center for Dermatology to your family & friends?: *
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    5) How do you rate how long you normally have to wait to be seen?: *
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    Name:

    Daytime Phone Number:

    E-Mail: