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* 1. Which provider did you most recently see?

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* 2. Does our office hours meet your needs?

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* 3. Are you able to get appointments within a reasonable time frame?

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* 4. Are you able to make same day appointments when sick?

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* 5. Are your calls answered quickly and professionally?

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* 6. Are you able yo get medical advice when the office is closed?

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* 7. How long did you wait in the waiting room after your appointment time?

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* 8. In your opinion, the waiting time in the waiting room was:

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* 9. How long did you wait in the exam room for your provider?

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* 10. In your opinion, the wait time in the exam room was:

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* 11. The front desk staff were friendly and helpful

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* 12. The front desk staff answered my questions

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* 13. The clinical staff listened to me

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* 14. The clinical staff were friendly and helpful

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* 15. The clinical staff answered my questions

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* 16. My provider listened to me

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* 17. My provider spent enough time with me

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* 18. My provider answered my questions

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* 19. My provider was friendly and helpful

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* 20. My provider gave me information I can understand

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* 21. My provider considered my personal or family beliefs

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* 22. My provider involves other doctors and caregivers in my care when needed

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* 23. My provider gives me good advice and treatment

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* 24. Have you ever been given information on what is means to have a medical home?

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* 25. Do you feel that Shah and Associates is your medical home?

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* 26. If you needed other services that we don't provide, did we help you find the services you needed?

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* 27. If you have been referred to a specialist or a community resource, did you find them helpful?

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* 28. Would you send your friends and family to us?

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* 29. Did someone talk to you about your health goals?

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* 30. Were you asked if you had seen any other providers since your last visit?

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* 31. Were you helped with making appointments to see other providers or for specialty care?

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* 32. If you rated us fair or poor on any question, please tell us about your experience

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