Specialty

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* 1. Specialty

Doctor/Specialist's Name

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* 2. Doctor/Specialist's Name

In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Doctor or Specialist.

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* 3. In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Doctor or Specialist.

In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Other clinical staff (e.g. nurse).

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* 4. In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Other clinical staff (e.g. nurse).

In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Front desk/administrative staff.

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* 5. In terms of sensitivity to your sexual orientation or gender identity, please rate your experience from 1 (lowest) to 5 (highest) with... Front desk/administrative staff.

Overall how satisfied were you with the quality of the doctor’s care? 1 being not satisfied and 5 being extremely satisfied.

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* 6. Overall how satisfied were you with the quality of the doctor’s care? 1 being not satisfied and 5 being extremely satisfied.

Please provide some details about your experience.

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* 7. Please provide some details about your experience.

Would you recommend this specialist to a friend?

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* 8. Would you recommend this specialist to a friend?

What is your sexual orientation

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* 9. What is your sexual orientation

Do you identify as transgender or gender non-conforming?

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* 10. Do you identify as transgender or gender non-conforming?

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