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* 1. Is the clinic a safe place to come for treatment?

0 Not Safe 5 Somewhat 10 Very Safe
i We adjusted the number you entered based on the slider’s scale.

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* 2. The confidentiality and privacy of staff are:

0 Not at All 5 Somewhat 10 Excellent
i We adjusted the number you entered based on the slider’s scale.

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* 3. The Qualities of services are:

0 Poor 5 Good 10 Excellent
i We adjusted the number you entered based on the slider’s scale.

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* 4. The explanation of the clinic rules and policies were:

0 Poor 5 Good 10 Excellent
i We adjusted the number you entered based on the slider’s scale.

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* 5. Staff response to my needs:

0 Not Satisfied 5 Somewhat 10 Very Satisfied
i We adjusted the number you entered based on the slider’s scale.

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* 6. Does the staff treat you with respect?

0 Not at all 5 Somewhat 10 Very
i We adjusted the number you entered based on the slider’s scale.

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* 7. How did you hear about us?

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* 8. Would you refer a friend to this program?

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* 9. Are there any other services you would like to see?

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* 10. Suggestions for improvement in Technology use?

T