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This survey is about your physical health and the people who help you with your health.

Answer the questions as well as you can, but don't worry if you don't understand a question or it doesn't apply. You can leave the question blank or call/text us (519-577-2907) and ask about it. At the end of the survey, there will be a space for anything else you want to tell us about your health and the care you receive.
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