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Taelor Conley Module 7
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Name
:
Did you have issues setting up an appointment?
Yes
No
How would you rate the service you received today?
1
2
3
4
5
Excellent
Poor
Were appointment times flexible with your schedule?
Yes
No
Are you apart of our online portal program?
Yes
No
How often do you see your physician in a year?
1-2
3-4
5-6
6 or More
Do you trust your physician to make the best medical decision for you?
Yes
No
How well did your physician listen to your needs/issues?
1
2
3
4
5
Excellent
Poor
Suggested improvements for our facility?
Mrs. Fauchier