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* 1. How likely is it that you would recommend FCPH to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 2. What was the main department you visited today to receive service?

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* 3. Overall, how satisfied or dissatisfied are you with FCPH?

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* 4. Where did you receive FCPH services?

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* 5. I was treated with courtesy and respect by FCPH staff.

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* 6. FCPH staff were professional, knowledgeable, and competent.

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* 7. Services and information were received in a timely and efficient manner.

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* 8. Overall, I am pleased with the services received.

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* 9. When did you receive services from FCPH

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

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* 11. What is your zip code?

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* 12. If you would like to be contacted about your experience, please leave your name and contact information below.

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