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* 1. Location of Today's Visit

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* 2. Was this your first time applying for assistance with our agency?

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* 3. Were you treated with respect?

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* 4. Was the curbside/waiting area clean, accessible, and welcoming?

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* 5. Would you recommend us to your friends or family?

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* 6. What are the strengths of your community?

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* 7. Do you have any suggestions for improvement?

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