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* 1. Please provide your contact information in case we have additional questions about your visit.

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* 2. What services did you receive today?

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* 3. What Provider(s) or Staff did you see today?

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* 4. An appointment was available when I needed it.

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* 5. The provider(s)/staff listened carefully to me and involved me in the decisions about my care

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* 6. Would you recommend our services to your friends and family?

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* 7. My culture, spiritual practices, and traditions were respected.

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* 8. Is there anyone that you would like to recognize today?

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* 9. Is there anything we could have done to improve our service to you today?  

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* 10. How was this survey completed? 

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