* 1. How many children do you have?

* 2. How old are your children? (Select all that apply)

* 3. What hours do you prefer for well visits?  (Select all that apply)

* 4. What hours do you prefer for sick visits? (Select all that apply)

* 5. If applicable, have you been able to get a sick visit within 24 hours?

* 6. What is your number one reason for coming to our practice?

* 7. How do you usually get to the office?

* 8. Would you be interested in receiving text messages from us?

* 9. If yes to the above question, of the following, what information would you like to receive via text message? (Select all that apply)

* 10. What is the best way to communicate with you regarding practice updates?

* 11. What is one thing we could do to improve our practice?

* 12. If you'd like to be entered in our raffle, please tell us how best to reach you!

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