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Patient Satisfaction Survey

Is this your first time at Ashley Health?
Yes
No
Which clinic did you visit?
What type of clinic did you visit?
Do you have an insurance plan?
Yes
No
How long did you need to wait for the appointment? (Past the appointment time)
Less than 30 min.
30 min. - 45 min.
45 min. - 60 min.
More than 60 min. =

Please rate the followings

Patient Satisfaction Survey

Is this your first time at Ashley Health?
Yes
No
Which clinic did you visit?
What type of clinic did you visit?
Do you have an insurance plan?
Yes
No
How long did you need to wait for the appointment? (Past the appointment time)
Less than 30 min.
30 min. - 45 min.
45 min. - 60 min.
More than 60 min. =

Please rate the followings

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