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* 1. Date of service

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* 2. Type of service

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* 3. Township/City

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* 4. Was the service helpful? 󠆶

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* 5. Was the staff respectful? 󠆶

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* 6. Would you return to PCHD for services? 󠆶

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* 7. After visiting PCHD, I would say: 

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* 8. How can we better serve you?

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* 9. Would you like to be contacted? 󠆶

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* 10. If yes, please provide e-mail or phone number

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