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Spider Vein Treatment Feedback

Dear Patient,

When you love what you do it shows. Thank you for taking the time to fill out this form and provide feedback to help us make our Spider Vein Treatment program the best it can be. We sincerely appreciate the trust you place in us by making VCPA a part of your healthcare needs. Your suggestions and comments are an important part in our ability to provide you with the best care available in the best manner possible.

Best Regards,

Sam Gupta, MD, MPH
President and CEO

The ultimate dream in life is to be able to do what you love and learn from it.
– Jeniffer L. Hewitt

First Name*
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Last Name*
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Email*
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Select Your Last Treatment Date*

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Birthday*
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First Impressions...

Ease of scheduling your appointment*
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Location and facility*
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Greeting/welcoming upon arrival*
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Wait time before you were seen*
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While You Were With Us...

Explanation about procedure*
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How comfortable did you feel*
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Skill level of the technician and doctor*
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Overall experience/care received*
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Suggestions/Comments:
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Take part in our Great Idea Contest! Once every month, we will give away a prize for an exceptional idea, something that can help us to improve our patient experience. Simply add your idea to your Comments, above. Prizes may include gift cards to restaurants and electronic items such as an iPad!

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Any questions? Email us, call 800.955.VEIN (8346) or visit us.