1. Default Section

Did you wait longer than 20 minutes to be seen?

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* 1. Did you wait longer than 20 minutes to be seen?

Was your visit the result of a scheduled appointment?

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* 2. Was your visit the result of a scheduled appointment?

Was the FSS Specialist professional and courteous?

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* 3. Was the FSS Specialist professional and courteous?

If No, please briefly explain:

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* 4. If No, please briefly explain:

Did the FSS Specialist answer your questions thoroughly?

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* 5. Did the FSS Specialist answer your questions thoroughly?

If No, please briefly explain:

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* 6. If No, please briefly explain:

Were your needs addressed?

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* 7. Were your needs addressed?

How can SHA better serve you?

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* 8. How can SHA better serve you?

Tenant Name

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* 9. Tenant Name

Specialist Name

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* 10. Specialist Name

Date of Visit

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* 11. Date of Visit

Date

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