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| 1. Is this your first visit to Sutton Ryan Aesthetic Center?
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| 2. Did you have a consultation prior to your procedure?
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| 3. Would you recommend our clinic to others?
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| 4. Which provider did you see at your last appointment? |
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Margaret Sutton, MD
Robyn Ryan, MD
Rebecca Reinke, PA-C
Leanne Carlson, PA-C
Jacklynn Kment, PA-C
Michelle Sitzman, PA-C
Michelle Fink, MA
Michele Harms, MA
JoAnna Fenicle, RN
Tova Rathbone, RN
Jan Beal, CST
Other
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| 5. What procedure/ treatment did you see us for at your last appointment?
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| 6. Ease of scheduling an appointment |
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| 7. Was your call returned in a timely manner
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| 8. Length of time waiting to see provider
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| 9. How well did the provider answer all your questions
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| 10. How well did the provider explain the procedure to you
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| 11. Knowledge/professionalism of provider?
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| 12. Knowledge/professionalism of other staff members
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| 13. How would you rate the appearance and atmosphere of our facility
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| 14. What did you like best about our clinic?
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| 15. Other suggestions/comments:
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| 16. What new procedure would you be interested in seeing Sutton Ryan Aesthetic Center provide?
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| 17. What procedures would you be interested in learning more about? (Check all that apply)
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FRAXEL® Laser Treatments
Filling Materials
Smartlipo™
BOTOX® or Dysport®
Laser Hair Reduction
Microdermabrasion
Chemical Peels
IPL Skin Rejuvenation
Laser Leg and Facial Vein Treatments
Professional Grade Skin Care Products
Financing Options
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| 18. How would you like us to contact you?
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Phone
Email
Mail
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| 19. How did you originally hear about us?
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Patient of Sutton Ryan Dermatology
Friends/Family Member
Print Publications (Journal Star, L Magazine, other)
Email Blast
Web Site (suttonryan.com)
Web Site Other- (i.e. kolnkgin.com, klkntv.com, neweddingday.com)
Television
Household Mailer
Other
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| Confirmation Code: Enter the code shown in the box before clicking on submit. | 
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