Dr. Tina Marcantel 201 W. Guadalupe Rd., Suite 202 Gilbert, AZ 85233 Your feedback is important to us. Would you please take a few moments to answer the following questions to help us serve you and other patients better? Just print this out and drop it in the mail or bring it on your next visit to Dr. Marcantel. Why did you visit Dr. Marcantel? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Did you feel that your condition improved with Dr. Marcantel's help? If so, in what specific ways? (e.g., weight loss, blood sugars, HbA1c, cholesterol, insomnia, blood pressure, etc.) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Did you visit our web site (www.drmarcantel.com)? If so, did you find the information there useful and informative? What comments or suggestions could you offer about the site? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ How do you feel we could improve our services to you and other patients? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Testimonials are an important tool for letting others know about our services. Do we have your permission to use your comments as a testimonial on our web site? If so, we will publish only your first name and last initial. _____Yes, you may use my comments on your web site. _____No, I prefer that you don't use my comments on your web site. ____________________________________ ___________________________________ (printed name) (signature) (date) Thank you for taking time to respond to these questions!