* 1. Please tell us the department/area you last visited at BID-Plymouth

* 2. Was this your first visit to that area?

* 3. What time was your appointment scheduled if known?

* 4. What is your age:

* 5. For the following questions, please rate your experience on a scale of 1-5. If a question does not apply, please skip to the next question.

* 6. Helpfulness of registration personnel

* 7. Ease of registration/check-in/scheduling process

* 8. Comfort of the waiting area

* 9. Comfort of the exam room

* 10. Cleanliness of the surroundings

* 11. Staff's level of professionalism when providing your test or treatment

* 12. How well staff worked as a team to provide care

* 13. Staff's sensitivity to your expressed needs

* 14. Overall rating of the care you received

* 15. How helpful was the education provided to you?

* 16. Patient's name and telephone number: (optional)

* 17. Comments

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