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1. What provider did you see?

What provider did you see? Vonda Klein, M.D.

Michael Mull,M.D.

Elizabeth Tachechian, M.D.

Gregg Bauer, M.D.

Cathy Watkins, NP

Carlos Alarcon, M.D.

April Ruffin, M.D.

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2. Please respond to how you agree with the following statements regarding the staff.

	Disagree	Neutral	Agree
Your check in process was efficient.	*Please respond to how you agree with the following statements regarding the staff. Your check in process was efficient. Disagree	Your check in process was efficient. Neutral	Your check in process was efficient. Agree
The check in staff was friendly.	The check in staff was friendly. Disagree	The check in staff was friendly. Neutral	The check in staff was friendly. Agree
The clinicial staff was friendly	The clinicial staff was friendly Disagree	The clinicial staff was friendly Neutral	The clinicial staff was friendly Agree

Comment

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3. Please select one of the three choices.

	Longer than expected	What I expected	Less than expected
How reasonable was your wait time for the services you received.	*Please select one of the three choices. How reasonable was your wait time for the services you received. Longer than expected	How reasonable was your wait time for the services you received. What I expected	How reasonable was your wait time for the services you received. Less than expected

4. Please respond to how you agree with the following statements.

	Strongly Disagree	Disagree	Netural	Agree	Strongly Agree	N/A
I was given explanation of diagnosis or treatment plan.	*Please respond to how you agree with the following statements. I was given explanation of diagnosis or treatment plan. Strongly Disagree	I was given explanation of diagnosis or treatment plan. Disagree	I was given explanation of diagnosis or treatment plan. Netural	I was given explanation of diagnosis or treatment plan. Agree	I was given explanation of diagnosis or treatment plan. Strongly Agree	I was given explanation of diagnosis or treatment plan. N/A
All my questions/concerns were answered by my provider.	All my questions/concerns were answered by my provider. Strongly Disagree	All my questions/concerns were answered by my provider. Disagree	All my questions/concerns were answered by my provider. Netural	All my questions/concerns were answered by my provider. Agree	All my questions/concerns were answered by my provider. Strongly Agree	All my questions/concerns were answered by my provider. N/A
The time spent with my provider was adequate.	The time spent with my provider was adequate. Strongly Disagree	The time spent with my provider was adequate. Disagree	The time spent with my provider was adequate. Netural	The time spent with my provider was adequate. Agree	The time spent with my provider was adequate. Strongly Agree	The time spent with my provider was adequate. N/A

Comment

5. Please respond to how you agree with the following statements:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
The provider had a good "bedside manner".	*Please respond to how you agree with the following statements: The provider had a good "bedside manner". Strongly Disagree	The provider had a good "bedside manner". Disagree	The provider had a good "bedside manner". Neutral	The provider had a good "bedside manner". Agree	The provider had a good "bedside manner". Strongly Agree	The provider had a good "bedside manner". N/A
I felt that my provider listened to me.	I felt that my provider listened to me. Strongly Disagree	I felt that my provider listened to me. Disagree	I felt that my provider listened to me. Neutral	I felt that my provider listened to me. Agree	I felt that my provider listened to me. Strongly Agree	I felt that my provider listened to me. N/A
Overall, you were satisfied with the medical care received by your Provider	Overall, you were satisfied with the medical care received by your Provider Strongly Disagree	Overall, you were satisfied with the medical care received by your Provider Disagree	Overall, you were satisfied with the medical care received by your Provider Neutral	Overall, you were satisfied with the medical care received by your Provider Agree	Overall, you were satisfied with the medical care received by your Provider Strongly Agree	Overall, you were satisfied with the medical care received by your Provider N/A
I would recommend my provider to others.	I would recommend my provider to others. Strongly Disagree	I would recommend my provider to others. Disagree	I would recommend my provider to others. Neutral	I would recommend my provider to others. Agree	I would recommend my provider to others. Strongly Agree	I would recommend my provider to others. N/A

Comment

6. Please use the space below to add any comments you may have.

Please use the space below to add any comments you may have.

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