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* 1. Who was your provider today?

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

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* 3. How easy or difficult  was it to schedule your appointment?

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

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* 5. How long did you have to wait in the waiting room?

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* 6. How long did you have to wait in the patient room for the provider?

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* 7. How would you rate the care you received from your provider today?

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* 8. How well did your provider answer your questions during your visit?

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* 9. Your Name and Date of Visit:

Thank you for your time and for choosing Randolph Pulmonary & Sleep Clinic!
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