♦ You should fill out this questionnaire only if you were the patient named on the envelope. You may need to get help from a family member or friend to answer the questions.
♦ Answer all the questions by checking the box to the left of your answer.
♦ Your response to this survey is voluntary but will provide us with important information.
♦ You are sometimes told to skip over some questions in this survey. When this happens, you will see an arrow with a note that tells you what question to answer next, like this: