* 1. Did you have a scheduled appointment today?

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

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

* 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?

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

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