* 1. How likely are you to change your doctor in the near future?

* 2. During your most recent visit, did your healthcare provider give you easy to understand information about these health questions or concerns?

* 3. During your most recent visit, did you talk with your healthcare provider about any health questions or concerns?

* 4. During your most recent visit, did your healthcare provider listen carefully to you?

* 5. How long have you been going to your healthcare provider?

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