Dear Patient:
We want to provide you with the highest quality health care possible in a comprehensive, compassionate, and cost-effective manner. Please take a moment to fill out the following survey. Your responses will help us to serve you better.
Please mark appropriate sex and age group:
Male
Female
Age?
18 - 25 26 - 35 36 - 45 46 - 55 55 - 65 66 & Above
Please choose the number that best describes your opinion:
-3 -2 -1 0 +1 +2 +3
1-15 minutes 6-30 minutes 31-45 minutes 46+ minutes
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Primary Care Group 117 E Clark Harrisburg, IL 62946
Sloan Medical Clinic 7211 US Highway 45 Carrier Mills, IL 62917
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