Did you have a scheduled appointment today?

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* 1. Did you have a scheduled appointment today?

Is this clinic your sole provider for medical care?

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* 2. Is this clinic your sole provider for medical care?

Where do you go for health care when the clinic is closed?

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* 3. Where do you go for health care when the clinic is closed?

Please respond to how you agree with the following statements:

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* 4. Please respond to how you agree with the following statements:

  Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
When you called the clinic, the person who answered the phone was prompt.
Your check in process was efficient.
The clinician staff was friendly to you.
All of your questions/concerns were answered by your Doctor/Midwife/Nurse Practitioner.
Overall, you were satisfied with your experience at the clinic today.
How reasonable was your wait time for the services you received?
Please use the space below to add any comments you may have.

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* 5. Please use the space below to add any comments you may have.

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