Exit this survey GCRS - Tell us how we are doing 1. Question Title * 1. Providers/Physician Seen Question Title * 2. Patient Name Question Title * 3. Patient Email Address Question Title * 4. Date Visited Date: Date Question Title * 5. Please rate your satisfaction with the promptness with which your calls were answered. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 6. Please rate your satisfaction with the courtesy of the staff over the telephone. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 7. Please rate you satisfaction with the ease of making appointments for checkups. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 8. Please rate your satisfaction with the ease with which you were able to make appointments for problems. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 9. Please rate your satisfaction with the amount of time your physician spent with you. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 10. Please rate your satisfaction with the courtesy of the staff when you arrived for your appointments. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 11. Please rate your satisfaction with the courtesy of the staff when you arrived for your appointments. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 12. Please rate your satisfaction with the general appearance of the office. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 13. Please rate your satisfaction with the courtesy of the medical assistants during your visit. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 14. Please rate your satisfaction with the overall quality of your care. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 15. Please rate your satisfaction with the availability of a physician after regular office hours. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 16. Please rate your satisfaction with the personal concern shown to you by your physician. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 17. Please rate your satisfaction with explanations of tests or procedures performed. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 18. Please rate your satisfaction with the instructions for taking medications. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 19. Please rate your satisfaction with your opportunity to ask questions. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 20. Please rate your satisfaction with the answers to your questions. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 21. Please rate your satisfaction with the explanation of payment. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 22. Please rate your satisfaction with the results of your care. Very Satisfied Satisfied Dissatisfied Very Dissatisfied Not Applicable Question Title * 23. Additional comments are welcomed. Done