It is our goal to provide you with the best possible medical care. To do that, it is important that we know your thoughts about the care you are receiving. We need to know the areas in which we are doing well, and the areas we need to improve. Your comments are strictly confidential, and results are used to accomplish quality improvement.

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1. If you would like to be contacted regarding the concerns that you express in this survey, please provide your current contact information below.