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* 1. How likely is it that you would recommend Starlight Pediatrics to a friend or family member?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 2. Overall, how satisfied or dissatisfied were you with your last visit to our office?

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

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* 4. How convenient was the appointment time you were able to get?

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

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* 6. How comfortable was the lobby and waiting area?

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* 7. Did your appointment with the Doctor start early, late or on time?

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* 8. Overall, how would you rate the care you received from Starlight Pediatrics?

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* 9. How much do you trust your child/ren phycisian to make medical decisions that are in your best interests?

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* 10. How well did the physician listen to your needs?

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* 11. How well did the physician answer your questions?

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* 12. How satisfied or dissatisfied were you with the amount of time the physician spent with you addressing your needs?

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* 13. Is there anything we could have done to improve your last visit?

T