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* 1. Are you at least 18 years of age?

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* 2. Are you a current patient of Goshen Medical Center? This means you have had one face to face visit with our medical or dental provider in the last twelve months.

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* 3. If you are a current patient, which facility did you visit?

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* 4. Are you a member of one or more of the following population groups?

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* 5. How clean was the facility?

  Exceptional Good Fair Not clean
Rate our level of cleanliness

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* 6. How friendly was the front office staff?

  Extremely friendly Very friendly Needs improvement Not very friendly
Rate our front desk customer service

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* 7. How friendly was the medical support staff? This would be the nurse, lab assistant, dental assistant and other clinical support staff.

  Extremely friendly Very friendly Needs Improvement Not very friendly
Rate our clinical staff's customer service

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* 8. What type of provider did you see?

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* 9. How would you rate your experience with the provider?

  Excellent Good Fair Not Good
Rate your satisfaction with your provider.

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* 10. How would you rate the location?

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* 11. If we were not able to assist you at the site you visited, did the staff refer you to another Goshen site?

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