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* 1. Please select your provider

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* 2. How affordable do you find your sliding scale fees? 

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* 3. If fees are not affordable and you would like to speak with one of our case managers about your sliding scale, please enter in your name and phone number please. 

Please select how well you think we are doing.

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* 4. EASE OF GETTING CARE
Scheduling, hours and location

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* 5. FRONT DESK
Friendly, helpful, answered questions

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* 6. Time spent in the waiting room

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* 7. Time spent in the exam room

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* 8. STAFF
Return calls, keep you up to date on test results, medications and referrals

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* 9. STAFF NURSES
Friendly,helpful and answers questions

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* 10. PROVIDER
Listens, takes time, answers questions, provides advice on self-care and treatment options

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* 11. PAYMENT
Collection of money/payment

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* 12. Facility: neat, clean comfort and safety

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* 13. Confidentiality:Personal information kept private

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* 14. Comments/Suggestions:

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* 15. If you would like to speak with someone regarding your visit today, please enter your name and number. One of our team members will reach out to you soon. Thank you!

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* 16. Do you use the patient portal? 

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