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* 1. Which hospital have you referred to?

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* 2. Please rate "Timeliness and Accessibility of Care" from a scale of 1 (poor) 10 (exceptional)

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 3. Please rate "Quality of Care" from a scale of 1 (poor) to 10 (exception)

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 4. Additional comments on how we can improve? Thank you!

T