Please rate the following:

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* How likely is it that you would recommend your doctor to a friend or family member?

Not at all likely
Extremely likely

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* Overall, how satisfied or dissatisfied were you with your last visit to our office?

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* How easy or difficult was it to schedule your appointment at a time that was convenient for you? 

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* Overall, how would you rate the service you received from the staff at our office?

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* Did your appointment with your provider start early, late or on time?

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* Overall, how would you rate the care you received from your provider?

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* How much do you trust your provider to make medical decisions that are in your best interests?

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* How well did your provider answer your questions?

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* How well did your provider explain your treatment options?

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* How well did your provider explain your follow-up care?

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* How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?

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* Was this your first visit with our office? 

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* Who did you see for your appointment?

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* Gender: How do you identify?

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* What is your age?

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* Would you like to be contacted about your survey responses?

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