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* 1. The clinic hours were convenient for me.

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* 2. The clinic was comfortable and clean.

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* 3. Staff members were courteous, respectful, and friendly.

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* 4. Staff members were respectful of my cultural background.

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* 5. Staff took time to explain things and answer any questions that I had.

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* 6. My needs were met during today's visit.

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* 7. How did you hear about this clinic?

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* 8. Additional comments or suggestions:

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