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* 1. What department were you seen in today?

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* 2. Pleas select the appropriate age range for yourself (the patient).

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* 3. Appointment available within a reasonable time?

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* 4. Overall efficiency of check-in process?

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* 5. Wait time in the exam room?

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* 6. If appointment was delayed, how well did we do at keeping you informed of the delay?

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* 7. If a referral was required, how did we do at making the process easy for you?

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* 8. Caring / Concern / Professionalism of the NTHS staff?

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* 9. Phone calls are returned promptly?

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* 10. Explanation of your health concerns / questions?

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* 11. Test results available within a reasonable amount of time?

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* 12. Clarity and effectiveness of the health information material provided?

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* 13. Wait time for your in-clinic prescriptions to be filled?

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* 14. Cleanliness of the clinic?

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* 15. Overall satisfaction of care from your medical home provider?

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* 16. Suggestions for improvement:

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