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* 1. How long has it been since your most recent visit with Chapel Hill Children's Clinic?

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* 2. How long have you been going to Chapel Hill Children's Clinic?

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* 3. How friendly is Chapel Hill Children's Clinic office staff?

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* 4. How easy or difficult was it to schedule your appointment at a time that was convenient for you?

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* 5. In the last 12 months, when you phoned Chapel Hill Children's Clinic’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

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* 6. In the last 12 months, did you phone Chapel Hill Children's Clinic’s office with a medical question after regular office hours?

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* 7. In the last 12 months, when you phoned Chapel Hill Children's Clinic’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?

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* 8. Overall, how often do you wait more than 15 minutes to see your doctor? (Wait time includes time spent in the waiting room and exam room.)

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* 9. During your most recent visit, did you talk with Chapel Hill Children's Clinic about any health questions or concerns?

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* 10. During your most recent visit, did your healthcare provider give you easy to understand information about these health questions or concerns?

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* 11. During your most recent visit, did Chapel Hill Children's Clinic seem to know the important information about your medical history?

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* 12. During your most recent visit, did your healthcare provider listen carefully to you?

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* 13. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?

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* 14. How well did your provider explain your follow-up care?

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* 15. In the last 12 months, when Chapel Hill Children's Clinic ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow up to give you those results?

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* 16. Is Chapel Hill Children's Clinic the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?

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* 17. Overall, how satisfied or dissatisfied were you with your last visit to our office?

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* 18. How comfortable was the lobby and waiting area?

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* 19. Overall, how would you rate the service you received from the staff at our office?

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* 20. In your opinion, how convenient is the location of our office?

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* 21. Overall, how would you rate the care you received from your provider?

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* 22. How likely is it that you would recommend Chapel Hill Children's Clinic to a friend or colleague?

Not at all likely
Extremely likely

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* 23. Is there anything we could have done to improve your last visit?

T