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* 1. How easy or difficult was it to schedule your appointment at a time that was convenient for you?

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* 2. Did your appointment with your provider start early, late or on time?

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* 3. How much do you trust your provider to make medical decisions that are in your best interests?

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* 4. How well did your provider answer your questions?

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* 5. How well did your provider explain your treatment options?

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* 6. How well did your provider explain your follow-up care?

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

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* 8. How likely is it that you would recommend your provider to a friend or colleague?

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* 9. Please enter any additional comments you would like to share...

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* 10. Please enter your First Name and Last Initial

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