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Clay-Platte Family Medicine Clinic Patient Satisfaction Survey

 

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1. Who is your primary healthcare provider?

	Choose one:
Our Providers:	Dr. OrtizDr. GrangerDr. JoslinDr. McDonaldDr. DelaneyDr. ChapmanDr. KuennenDr. DayLori TutonDanielle KeithPam Kepus Who is your primary healthcare provider?   Our Providers:   Choose one:

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2. What is your gender?

What is your gender?   Male

Female

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3. What is your age range in years?

What is your age range in years?   0-17 18-24 25-34 35-44 45-54 55-64 65-74 over 75

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4. How long have you been a patient at Clay Platte Family Medicine Clinic?

How long have you been a patient at Clay Platte Family Medicine Clinic?   0-6 months

7-12 months

1-2 years

3-5 years

more than 5 years