PIHCN Physician Performance Evaluation
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1
. Which doctor(s) do you see? (Please mark all that apply)
Which doctor(s) do you see? (Please mark all that apply)
Dr. Susan Godman
Dr. Stephanie Nishek
Dr. Gemie Kohler
Dr. Lois Eaton
Dr. Cheryl Kasdorf
2
. During a typical office visit, does your doctor spend too much time with you, too little time with you, or about the right amount of time with you?
During a typical office visit, does your doctor spend too much time with you, too little time with you, or about the right amount of time with you?
Much too much
Somewhat too much
Slightly too much
About the right amount
Slightly too little
Somewhat too little
Much too little
3
. How much do you trust your doctor to make medical decisions that are in your best interests?
How much do you trust your doctor to make medical decisions that are in your best interests?
A great deal
A lot
A moderate amount
A little
Not at all
4
. How helpful is your doctor at explaining your medical condition(s)?
How helpful is your doctor at explaining your medical condition(s)?
Extremely helpful
Very helpful
Moderately helpful
Slightly helpful
Not at all helpful
5
. How well does your doctor listen to you?
How well does your doctor listen to you?
Extremely well
Very well
Moderately well
Slightly well
Not at all well
6
. How quickly does your doctor's staff help you when you need help?
How quickly does your doctor's staff help you when you need help?
Extremely quickly
Very quickly
Moderately quickly
Slightly quickly
Not at all quickly
7
. How friendly is your doctor's office staff?
How friendly is your doctor's office staff?
Extremely friendly
Very friendly
Moderately friendly
Slightly friendly
Not at all friendly
8
. Overall, are you satisfied with your doctor, neither satisfied nor dissatisfied with him/her, or dissatisfied with him/her?
Overall, are you satisfied with your doctor, neither satisfied nor dissatisfied with him/her, or dissatisfied with him/her?
Extremely satisfied
Very satisfied
Moderately satisfied
Neither satisfied nor dissatisfied
Moderately dissatisfied
Very dissatisfied
Extremely dissatisfied
9
. How likely are you to recommend your doctor to family or friends?
How likely are you to recommend your doctor to family or friends?
Extremely likely
Very likely
Moderately likely
Slightly likely
Not at all likely
10
. Please take a moment to add any comments, concerns or information that you think could improve your relationship with your doctor or improve your satisfaction with the office staff. Feel free to expand upon any of your answers to previous questions here also.
Please take a moment to add any comments, concerns or information that you think could improve your relationship with your doctor or improve your satisfaction with the office staff. Feel free to expand upon any of your answers to previous questions here also.
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