{"id":31,"date":"2018-10-26T02:00:37","date_gmt":"2018-10-26T02:00:37","guid":{"rendered":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/?page_id=31"},"modified":"2018-10-26T02:07:03","modified_gmt":"2018-10-26T02:07:03","slug":"patient-satisfaction-survey-form","status":"publish","type":"page","link":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/patient-satisfaction-survey-form\/","title":{"rendered":"Patient Satisfaction Survey form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f32-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"32\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/pages\/31#wpcf7-f32-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"32\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f32-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>*PLEASE NOTE:<br \/>\n\u2192 An answer is required for every question unless marked \"(optional)\".<br \/>\n\u2192 If a multiple-choice question does not apply to you, Click N\/A.<br \/>\n\u2192 If a question with a text box does not apply to you, type N\/A or n\/a.<br \/>\nThanks for helping us improve the services we provide!\n<\/p>\n<p>_______________________________________________________________<br \/>\n\u25baQ1. Likelihood of you recommending our practice to others<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q1_Likelihood_of_you_Recommending_to_Others\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"Q1_Likelihood_of_you_Recommending_to_Others\" value=\"Not Likely\" \/><span class=\"wpcf7-list-item-label\">Not Likely<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"Q1_Likelihood_of_you_Recommending_to_Others\" value=\"Probably\" \/><span class=\"wpcf7-list-item-label\">Probably<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"Q1_Likelihood_of_you_Recommending_to_Others\" value=\"Absolutely\" \/><span class=\"wpcf7-list-item-label\">Absolutely<\/span><\/span><\/span><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Scheduling of Appointments:<br \/>\n__________________________\n<\/p>\n<p>\u25baQ2. Length of time to reach us for a WELL Appointment<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q2_Length_of_time_to_reach_us_for_WELL_Appt:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ3. Courtesy of WELL Appointment scheduler<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q3_Courtesy_of_WELL_Appointment_scheduler:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ4. Length of time to reach us for a SICK Appointment<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q4_Length_of_time_to_reach_us_for_SICK_Appt:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ5. Courtesy of SICK Appointment scheduler<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q5_Courtesy_of_SICK_Appointment_scheduler:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ6. Appointment time availability to see child in a timely manner<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q6_Appointment_time_availability_to_see_child_in_a_timely_manner:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ7. Helpfulness of SICK Appointment scheduler<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q7_Helpfulness_of_SICK_Appointment_scheduler:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ8. Additional Comments about schedulers<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q8_Comments_about_schedulers\"><textarea cols=\"30\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q8_Comments_about_schedulers\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Receptionists upon Arrival\/Departure:<br \/>\n____________________________________\n<\/p>\n<p>\u25baQ9. Your greeting and efficiency upon check-in<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q9_Your_greeting_and_efficiency_upon_check-in:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ10. Your greeting and efficiency upon check-out<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q10_Your_greeting_and_efficiency_upon_check-out:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ11. Courtesy and personal attention to your needs from the receptionists<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q11_Courtesy_and_personal_attention_to_your_needs_from_the_receptionists:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ12. Additional Comments about receptionists<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q12_Comments_about_receptionists\"><textarea cols=\"30\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q12_Comments_about_receptionists\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Your Appointment:<br \/>\n________________\n<\/p>\n<p>\u25baQ13. Convenience of appointment time<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q13_Convenience_of_appointment_time:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q13_Convenience_of_appointment_time:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q13_Convenience_of_appointment_time:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q13_Convenience_of_appointment_time:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q13_Convenience_of_appointment_time:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q13_Convenience_of_appointment_time:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ14. Pleasantness of wait<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q14_Pleasantness_of_wait:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q14_Pleasantness_of_wait:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q14_Pleasantness_of_wait:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q14_Pleasantness_of_wait:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q14_Pleasantness_of_wait:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q14_Pleasantness_of_wait:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ15. Time waiting in reception area<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q15_Time_waiting_in_reception_area:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q15_Time_waiting_in_reception_area:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q15_Time_waiting_in_reception_area:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q15_Time_waiting_in_reception_area:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q15_Time_waiting_in_reception_area:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q15_Time_waiting_in_reception_area:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ16. Pleasantness and comfort of exam room<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q16_Pleasantness_and_comfort_of_exam_room:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q16_Pleasantness_and_comfort_of_exam_room:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q16_Pleasantness_and_comfort_of_exam_room:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q16_Pleasantness_and_comfort_of_exam_room:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q16_Pleasantness_and_comfort_of_exam_room:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q16_Pleasantness_and_comfort_of_exam_room:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ17. How long did you wait in the exam area?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q17_How_long_you_waited_in_the_exam_area\"><textarea cols=\"15\" rows=\"1\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q17_How_long_you_waited_in_the_exam_area\"><\/textarea><\/span>\n<\/p>\n<p>\u25baQ18. What was the time of your appointment?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q18_Time_of_your_appointment\"><textarea cols=\"15\" rows=\"1\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q18_Time_of_your_appointment\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Your Nurse:<br \/>\n__________\n<\/p>\n<p>\u25baQ19. Friendliness<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q19_Friendliness_of_nurse:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q19_Friendliness_of_nurse:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q19_Friendliness_of_nurse:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q19_Friendliness_of_nurse:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q19_Friendliness_of_nurse:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q19_Friendliness_of_nurse:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ20. Considerate of your needs\/concerns<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q20_Consideration_by_nurse_of_your_needs_concerns:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ21. Compassionate\/Caring<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q21_Compassion_caring_by_nurse:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q21_Compassion_caring_by_nurse:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q21_Compassion_caring_by_nurse:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q21_Compassion_caring_by_nurse:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q21_Compassion_caring_by_nurse:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q21_Compassion_caring_by_nurse:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ22. Additional Comments about your nurse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q22_Comments_about_your_nurse\"><textarea cols=\"30\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q22_Comments_about_your_nurse\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Your Doctor:<br \/>\n___________\n<\/p>\n<p>\u25baQ23. Length of time spent with doctor<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q23_Length_of_time_spent_with_doctor:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q23_Length_of_time_spent_with_doctor:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q23_Length_of_time_spent_with_doctor:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q23_Length_of_time_spent_with_doctor:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q23_Length_of_time_spent_with_doctor:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q23_Length_of_time_spent_with_doctor:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ24. Considerate of your needs\/concerns<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q24_Consideration_by_doctor_of_your_needs_concerns:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ25. Friendliness<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q25_Friendliness_of_doctor:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q25_Friendliness_of_doctor:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q25_Friendliness_of_doctor:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q25_Friendliness_of_doctor:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q25_Friendliness_of_doctor:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q25_Friendliness_of_doctor:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ26. Compassionate\/Caring<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q26_Compassion_caring_of_doctor:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q26_Compassion_caring_of_doctor:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q26_Compassion_caring_of_doctor:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q26_Compassion_caring_of_doctor:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q26_Compassion_caring_of_doctor:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q26_Compassion_caring_of_doctor:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ27. Doctor's efforts to include you in decisions concerning treatment options<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q27_Effort_of_doctor_to_include_you_in_decisions:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ28. Your confidence in this doctor<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q28_Your_confidence_in_this_doctor:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q28_Your_confidence_in_this_doctor:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q28_Your_confidence_in_this_doctor:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q28_Your_confidence_in_this_doctor:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q28_Your_confidence_in_this_doctor:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q28_Your_confidence_in_this_doctor:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ29. Doctor seen today<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q29_Doctor_seen_today:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Sandra Weidner<\/span><input type=\"radio\" name=\"Q29_Doctor_seen_today:\" value=\"Sandra Weidner\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Ruth Spillerman<\/span><input type=\"radio\" name=\"Q29_Doctor_seen_today:\" value=\"Ruth Spillerman\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Rebecca Ezard<\/span><input type=\"radio\" name=\"Q29_Doctor_seen_today:\" value=\"Rebecca Ezard\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Robert Cordes<\/span><input type=\"radio\" name=\"Q29_Doctor_seen_today:\" value=\"Robert Cordes\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">Timothy Tam<\/span><input type=\"radio\" name=\"Q29_Doctor_seen_today:\" value=\"Timothy Tam\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ30. Additional Comments about your doctor<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q30_Comments_about_your_doctor\"><textarea cols=\"30\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q30_Comments_about_your_doctor\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>Miscellaneous:<br \/>\n_____________\n<\/p>\n<p>\u25baQ31. Comfort in office<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q31_Comfort_in_office:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q31_Comfort_in_office:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q31_Comfort_in_office:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q31_Comfort_in_office:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q31_Comfort_in_office:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q31_Comfort_in_office:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ32. Cleanliness of office<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q32_Cleanliness_of_office:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q32_Cleanliness_of_office:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q32_Cleanliness_of_office:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q32_Cleanliness_of_office:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q32_Cleanliness_of_office:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q32_Cleanliness_of_office:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ33. Cleanliness of exam room<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q33_Cleanliness_of_exam_room:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q33_Cleanliness_of_exam_room:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q33_Cleanliness_of_exam_room:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q33_Cleanliness_of_exam_room:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q33_Cleanliness_of_exam_room:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q33_Cleanliness_of_exam_room:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ34. Personal attention received<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q34_Personal_attention_received:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q34_Personal_attention_received:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q34_Personal_attention_received:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q34_Personal_attention_received:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q34_Personal_attention_received:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q34_Personal_attention_received:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ35. Parking<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q35_Parking:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q35_Parking:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q35_Parking:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q35_Parking:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q35_Parking:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q35_Parking:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ36. Convenience of office hours<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q36_Convenience_of_office_hours:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q36_Convenience_of_office_hours:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q36_Convenience_of_office_hours:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q36_Convenience_of_office_hours:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q36_Convenience_of_office_hours:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q36_Convenience_of_office_hours:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ37. Our sensitivity to your needs<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q37_Our_sensitivity_to_your_needs:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q37_Our_sensitivity_to_your_needs:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q37_Our_sensitivity_to_your_needs:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q37_Our_sensitivity_to_your_needs:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q37_Our_sensitivity_to_your_needs:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q37_Our_sensitivity_to_your_needs:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ38. Overall cheerfulness of the staff<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q38_Overall_cheerfulness_of_the_staff:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q38_Overall_cheerfulness_of_the_staff:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q38_Overall_cheerfulness_of_the_staff:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q38_Overall_cheerfulness_of_the_staff:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q38_Overall_cheerfulness_of_the_staff:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q38_Overall_cheerfulness_of_the_staff:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ39. Overall rating of care you received<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q39_Overall_rating_of_care_you_received:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Poor<\/span><input type=\"radio\" name=\"Q39_Overall_rating_of_care_you_received:\" value=\"Poor\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Fair<\/span><input type=\"radio\" name=\"Q39_Overall_rating_of_care_you_received:\" value=\"Fair\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Good<\/span><input type=\"radio\" name=\"Q39_Overall_rating_of_care_you_received:\" value=\"Good\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Exceptional<\/span><input type=\"radio\" name=\"Q39_Overall_rating_of_care_you_received:\" value=\"Exceptional\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">N\/A<\/span><input type=\"radio\" name=\"Q39_Overall_rating_of_care_you_received:\" value=\"N\/A\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ40. How did you hear about our office?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q40_How_did_you_hear_about_our_office\"><textarea cols=\"30\" rows=\"1\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q40_How_did_you_hear_about_our_office\"><\/textarea><\/span>\n<\/p>\n<p>Most convenient time(s) for appointments:<br \/>\n(You may click more than one choice)<br \/>\n\u25baQ41. Morning appointments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q41_Morning_appts:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Yes<\/span><input type=\"radio\" name=\"Q41_Morning_appts:\" value=\"Yes\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">No<\/span><input type=\"radio\" name=\"Q41_Morning_appts:\" value=\"No\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ42. Afternoon appointments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q42_Afternoon_appts:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Yes<\/span><input type=\"radio\" name=\"Q42_Afternoon_appts:\" value=\"Yes\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">No<\/span><input type=\"radio\" name=\"Q42_Afternoon_appts:\" value=\"No\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ43. Evening appointments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q43_Evening_appts:\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Yes<\/span><input type=\"radio\" name=\"Q43_Evening_appts:\" value=\"Yes\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">No<\/span><input type=\"radio\" name=\"Q43_Evening_appts:\" value=\"No\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u25baQ44. Any other suggestions or additional comments for us to consider<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Q44_Other_suggestions_or_comments_for_us\"><textarea cols=\"30\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Q44_Other_suggestions_or_comments_for_us\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>We thank you for your trust and the opportunity to assist you in your child\/children's healthcare!\n<\/p>\n<p>\u25baQ45. Name (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Name_OPTIONAL\"><textarea cols=\"30\" rows=\"1\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Name_OPTIONAL\"><\/textarea><\/span>\n<\/p>\n<p>\u25baQ46. Date (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Date_OPTIONAL\"><textarea cols=\"30\" rows=\"1\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Date_OPTIONAL\"><\/textarea><\/span><br \/>\n_______________________________________________________________\n<\/p>\n<p>\u25a0 Please review this form to make sure that an answer was given for every question.\n<\/p>\n<p>\u25a0 Then press the submit button below and this form will be sent to us.\n<\/p>\n<p>\u25a0 Thanks again for your time and effort to help us improve our service to you and all other patients!\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"random-knowledge-quiz\"><label><span class=\"wpcf7-quiz-label\">Authentication Quiz: The number of days in a week is?<\/span> <input size=\"40\" class=\"wpcf7-form-control wpcf7-quiz\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" type=\"text\" name=\"random-knowledge-quiz\" \/><\/label><input type=\"hidden\" name=\"_wpcf7_quiz_answer_random-knowledge-quiz\" value=\"0ce32f4e2581e9484235f9f526bfbc7a\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":23,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-31","page","type-page","status-publish","has-post-thumbnail","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PamJYw-v","_links":{"self":[{"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/pages\/31","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/comments?post=31"}],"version-history":[{"count":2,"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/pages\/31\/revisions"}],"predecessor-version":[{"id":36,"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/pages\/31\/revisions\/36"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/media\/23"}],"wp:attachment":[{"href":"https:\/\/secure2web2.com\/CCWyo\/NewWPInstall\/wp-json\/wp\/v2\/media?parent=31"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}