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1. What agency provides Telephone Reassurance?

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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 telephone reassurance calls?

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6. How satisfied are you with the time the call is made?

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7. How often do you miss the telephone call because you have a schedule conflict?

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8. How would you rate the friendliness and courtesy of the people who call?

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9. Overall, how would you rate the telephone service?

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

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11. Additional Comments

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