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Date of your visit:
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Which provider did you see at this visit?: |
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Was it easy getting through our phone lines to schedule an appointment?: |
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Were you able to make an appointment for a date and time that was reasonable and convenient for you?: |
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Was the receptionist who greets you as you walk in helpful and friendly?: |
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Was the person who escorted you to the exam room courteous and helpful?: |
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Did the staff introduce him/herself to you?: |
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Did the doctor or nurse practitioner explain things in words you could understand?: |
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Did the doctor or nurse practioner address your concerns today?: |
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Were you given clear instructions or advice about your health today?: |
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Did you get instructions about when to return for another visit?: |
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Overall, how satisfied were you with your visit today?: |
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