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* 1. Were you greeted in a professional manner?

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* 2. Did you have enough privacy when speaking with the counselor?

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* 3. How would you rate today's visit?

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* 4. What would have made your  visit better for you? (Name/phone # optional)

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* 5. Did you have an appointment or walk-in for services?

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* 6. How long did you have to wait before being seen by VA Staff?

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* 7. What hours of service would better meet your needs?

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* 8. Have you ever used the VA van?

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* 9. If yes, how easy was it to schedule a ride?

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* 10. What would have made your ride better for you?

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* 11. How did you hear about us?

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* 12. Other (please specify):

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* 13. How do you stay up-to-date with information?

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* 14. Other (please specify):

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* 15. How would you like us to keep you updated on VA information?

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