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* 1. What is your first name?

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* 2. Where do you live?

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* 3. What is your age?

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* 4. What is your gender?

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* 5. Have you ever used physiotherapist services?

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* 6. Did your family doctor prescribe the physiotherapy services?

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* 7. How did you get to your physiotherapy appointment(s)?  Select all that apply.

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* 8. In the last 24 months, how many times did you visit a physiotherapist for services?

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* 9. If you used physiotherapy services within the last 24 months, where was the clinic you visited located?

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* 10. Did you have to stay overnight in the town or city you visited for your physiotherapy appointments?

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* 11. How long did you have to wait to get your first physiotherapy appointment?

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* 12. Overall, how satisfied were you with the physiotherapy services you received?

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* 13. Would you find it beneficial to have a local physiotherapist clinic in Fairview, AB?

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* 14. What other health care services you would like to see in Fairview, AB?

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* 15. Thank you for completing the Survey!  Your responses are STRICTLY CONFIDENTIAL and are collected for the purposes of this Survey only!
In the event that you are the LUCKY WINNER of $100.00 Chamber Change, please provide us with a contact email or phone number! Winner to be announced Feb. 25, 2019.

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