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1. What agency provides Friendly Visiting?

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2. Age

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3. Gender

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4. Race

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5. How long have you been receiving friendly visiting?

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6. How satisfied are you with the time of the visits?

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7. How would you rate the friendliness and courtesy of the people who visit you?

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8. Overall, how satisfied are you with the friendly visiting service?

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9. How often do you see friends, relatives, and neighbors?

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10. Do you feel that receiving friendly visiting has helped reduce your social isolation?

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11. Additional Comments

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