Thank you for choosing the Margaret Mary Health Center for your health care needs. By sharing your impressions of your recent visit, you can help our team improve the quality of care and service you receive.

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* 1. Are you a new patient or an established patient?

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* 2. Date of Your Visit:

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* 3. Name of Your Provider:

On a scale of 1 to 5, with '1' being 'Strongly Disagree' and '5' being 'Strongly Agree,' please rate your care.

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* 4. The location of the clinic is easy to find.

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* 5. My provider is available when I need care.

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* 6. My provider listened and answered my questions.

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* 7. I trust my provider with my medical care.

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* 8. I feel confident managing my care at home.

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* 9. I am notified of any test results, medication changes or referrals to specialists.

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* 10. I do not have any concerns about my privacy while at the clinic.

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* 11. The cleanliness of the clinic was acceptable.

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* 12. There was good communication between members of the clinic team about my care.

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* 13. I was involved in the decision making/planning process of my care as much as I wanted to be.

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* 14. I will recommend this provider and clinic to my family and friends.

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* 15. My overall satisfaction with my care was high.

Thank you for completing our survey. We value your input to improve our services. 

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* 16. Name (Optional):

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