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Your Provider

The questions in this survey will refer to the provider named in Question 1 as “this provider.” Please think of that person as you answer the survey.

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* 1. What is your provider's name?

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* 2. At which location do you see this provider?

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* 3. Is this the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?

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* 4. How long have you been going to this provider?

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