Marias Healthcare appreciates your time in completing this survey.

Your answers will be reviewed by both the management and Board of Directors. Your feedback is important to us as we strive to provide the best care possible.

At which office were you seen?

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* 1. At which office were you seen?

Which Physician did you see?

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* 2. Which Physician did you see?

Date of appointment?

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* 3. Date of appointment?

Was this your first visit to Marias Healthcare?

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* 4. Was this your first visit to Marias Healthcare?

How would you rate the following?

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* 5. How would you rate the following?

  Very Good Good Fair Poor Very Poor
Convenience of office hours.
Comfort of reception area.
Comfort of exam rooms.
How would you rate the confidentiality of:

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* 6. How would you rate the confidentiality of:

  Very Good Good Fair Poor Very Poor N/A
Receptionists
Nurses/Clinical Staff
Physicians
Office Staff/Account Services

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