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	First name:		Last name:

	Email address:

	Telephone number:


	How easy or convenient was scheduling your appointment?:


	Did you understand our fees and feel they were a good value?: (Required)

	Why did you choose this hospital?: (Required)

	Do you have any suggestions about how we can improve our service to you?: (Required)

'; wspFN_1781098818_10848_63 ( wspVAR_1781098818_10848_62 );