How long have you been going to Samantha Cole?

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* 1. How long have you been going to Samantha Cole?

How well did your provider listen to your needs?

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* 2. How well did your provider listen to your needs?

How well did your provider answer your questions?

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* 3. How well did your provider answer your questions?

Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Samantha Cole?

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* 4. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Samantha Cole?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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In the last 12 months, when you phoned your healthcare provider’s office during regular office hours, how often did you get an answer to your medical question that same day?

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* 5. In the last 12 months, when you phoned your healthcare provider’s office during regular office hours, how often did you get an answer to your medical question that same day?

In general, how would you rate your overall mental or emotional health?

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* 6. In general, how would you rate your overall mental or emotional health?

In the last 12 months, how often did Samantha Cole explain things in a way that was easy to understand?

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* 7. In the last 12 months, how often did Samantha Cole explain things in a way that was easy to understand?

Would you recommend Samantha Cole’s office to your family and friends?

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* 8. Would you recommend Samantha Cole’s office to your family and friends?

Do you have any other comments, questions, or concerns?

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* 9. Do you have any other comments, questions, or concerns?

Are you male or female?

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* 10. Are you male or female?

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