Pain Institute of Tampa
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Give Us Feedback!

In an effort to better serve our patients, the staff and physicians would like to invite you to offer some feedback. Please help us to prioritize which area(s) we can improve to better take care of you. Thank you for your time. Your opinion is very important to us!

How would you rate the following aspects of our office? Please assign a number on a scale from 1 to 10 where "1" represents "Needs a lot of improvement" and "10" represents "Perfect as is".


1 2 3 4 5 6 7 8 9 10
Poor Satisfactory Great


1. test question:

2. Your Doctor (please select his/her name):


Additional Comments:






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