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

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* 2. How easy or difficult was it to schedule your appointment at a time that was convenient for you?

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

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* 4. How much do you trust your provider to make medical decisions that are in your best interests?

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* 5. How well did your provider listen to your needs?

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* 6. How well did your provider answer your questions?

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* 7. How well did your provider explain your treatment options?

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* 8. How well did your provider explain your follow-up care?

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* 9. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?

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* 10. Is there anything we could have done to improve your last visit? Also, please let us know which health care provider you saw at this appointment.

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