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1. DATE OF SERVICE

When was your appointment?
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* 3. ACCESS TO CARE

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

* 4. COCHLEAR IMPLANT CLINICIAN

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

* 5. FACILITY RATING

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

* 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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