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* 1. DATE OF SERVICE

When did you have your appointment?
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* 3. ACCESS TO CARE

  Poor Fair Good Very Good Excellent N/A
Seen for my appointment on time:
Insurance information addressed:
Helpfulness of the front office staff:
Billing concerns or questions were addressed:
Ease of scheduling an appointment:
Able to reach the front office staff during business hours:

* 4. AUDIOLOGIST

  Poor Fair Good Very Good Excellent N/A
Amount of time spent with you and/or your child:
All of your questions and concerns were addressed:
Evaluation results were explained:
Overall quality of care provided by the audiologist:
Understanding and caring shown toward you and/or your family:
Clear recommendations for further care or treatment were provided:
Written documentation/report received within 15 working days, if requested:

* 5. FACILITY RATING

  Poor Fair Good Very Good Excellent N/A
Cleanliness of treatment/test room:
Availability of parking:
Cleanliness of restroom:
Cleanliness of waiting area:
Comfort of waiting area:

* 6. Would you recommend the UTD Callier Center for Communication Disorders to others ?

  Yes No
Refer/Recommend ?

* 7. Was there someone or something that stood out as exceptional (or poor) during your visit ? Please explain:

* 8. PATIENT FOLLOW-UP: Would you like someone to call you to discuss your comments ?

THANK YOU VERY MUCH FOR COMPLETING OUR SURVEY

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