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* 1. Name of the provider you recently saw?

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* 2. Ease of making your appointment:

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* 3. Getting evening/weekend care when needed:

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* 4. Getting advice or help after-hours:

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* 5. Amount of time to get prescription refills or test results:

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* 6. Taking time to answer your questions:

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* 7. Instructions regarding medications/ follow-up care:

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* 8. Advice given to you on ways to stay healthy:

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* 9. Assistance with mental health resources (if needed):

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* 10. Ease of getting a referral (if needed):

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