This survey is strictly confidential and is only intended to improve the quality of care Vitality has pledged to deliver among its patients and to the community. 

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* 2. What is your gender?

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* 7. Please rate the following:

  Worst -- 1 2 3 4 5 -- Best
Does your clinician listen to you and understand your concerns?
Does your clinician let you explain your issues freely?
Does your clinician make you feel warm, accepted, and not judged?
Do you feel that your clinician actively participates and is engaged during your sessions?
Is your clinician able to review your issues and goals with you clearly?
Does your clinician return your phone calls at a timely manner?
How would you rate your clinician in terms of professionalism?
How would you rate your clinician in terms of his or her knowledge of your issue?
How likely is it that you would recommend this office to a friend or colleague?

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* 8. Any other comments about your clinician, Vitality and its staff?

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* 9. Optional: Your Name

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