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We like to keep it safe, sound, and anonymous. Neither the practice nor the practitioners will be able to see the answers you have given. In addition, we do not request data that can be linked to a single person and identify them in some way. However, in order to provide insight on the performance, we would like to ask you to give some general characteristics of the treatment you have received.
When did the last appointment take place?
RadDatePicker
RadDatePicker
Open the calendar popup.
Who was your practitioner for this appointment?
select
At what location did this appointment take place?
select
What is your year of birth?
What is your gender?
select
What are the first four digits of your postal code?
What is your health insurance company?
select
What are or where you treated for? Choose the kind of care that comes closest.
select
In which language do you want to fill out the rest of the questionnaire?
select