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I am a

1. Overall, the Medical Services received were / are

Please Rate Our...

2. Professional Treating Staff

3. Administrative Staff

4. Management Staff

5. Communication

Please Comment on our timeliness and accuracy...

6. Are we responsive to your concerns?

7. Are the billing of services timely?

8. Are the billing of services accurate?

9. Are treatments conveniently scheduled?

Please Comment on choosing Marden or Health Care Plus...

10. If you were referred to us, who referred you?

11. Had you heard about us before we provided services?

12. If yes, how did you hear of us?

13. Please rate your overall experience with us.

Please provide your recommendations and comments...

14. Would you recommend Marden or Health Care Plus?

15. Would you like us to contact you?

16. If "Yes", please provide your contact information.
Name:

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e-mail Address:

17. Please provide any additional comments.

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