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* 1. We would like you to think about your recent experience of our service.

How likely are you to recommend our service to friends or family if they needed similar treatment?

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* 2. Please tell us the main reason for selecting your statement.

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* 3. Sex

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* 4. What age are you?

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* 5. What ethnic group are you?

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* 6. Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last at least twelve months?(include any issues/problems relating to old age)

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