Please us N/A if you have no basis for answering a question or if it was not applicable to anything you experienced during this process.

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* 1. I am... Please mark one:

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* 2. Please indicate which of the following are true for you (check all that apply):

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* 6. Overall Strengths:

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* 7. Overall Weaknesses/Opportunities for Improvement:

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* 8. Other comments:

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* 9. Please provide your overall assessment of Dr. Pescador:

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* 10. If you wish, please provide your name:

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