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* 1. How likely is it that you would recommend this company to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 2. Do you have any other comments, questions, or concerns?

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* 3. How well did our customer service representative answer your question or solve your problem?

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* 4. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

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* 5. During your most recent visit, did you talk with your healthcare provider about any health questions or concerns?

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* 6. In the last 12 months, how many times did you visit your healthcare provider?

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* 7. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your healthcare provider?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
.

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* 8. How long have you been going to your healthcare provider?

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* 9. Overall, how would you rate the service you received from the staff at our office?

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* 10. Would you recommend your healthcare provider’s office to your family and friends?

T