Clinix Healing Center Patient Survey

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1. Do you have one person or group that you think of as your personal doctor or health care team?

Do you have one person or group that you think of as your personal doctor or health care team?   Yes No N/A

Please name if applicable.

2. How easy is it for you to get medical care when you need it?

How easy is it for you to get medical care when you need it?   Very Easy Easy Difficult Very Difficult

3. Over the past few months, how easy has it been for you to do the following?

	Very Easy	Easy	Difficult	Very Difficult
Make appointments	*Over the past few months, how easy has it been for you to do the following? Make appointments Very Easy	Make appointments Easy	Make appointments Difficult	Make appointments Very Difficult
Get prescriptions refilled	Get prescriptions refilled Very Easy	Get prescriptions refilled Easy	Get prescriptions refilled Difficult	Get prescriptions refilled Very Difficult
Get lab results	Get lab results Very Easy	Get lab results Easy	Get lab results Difficult	Get lab results Very Difficult
Talk to a nurse	Talk to a nurse Very Easy	Talk to a nurse Easy	Talk to a nurse Difficult	Talk to a nurse Very Difficult
Talk to your doctor	Talk to your doctor Very Easy	Talk to your doctor Easy	Talk to your doctor Difficult	Talk to your doctor Very Difficult

4. When you visit your doctor's office, how often is it well organized, efficient and not wasteful of your time?

When you visit your doctor's office, how often is it well organized, efficient and not wasteful of your time?   Very Often Sometimes Rarely Never N/A

5. At this office, how often do the following people listen and respond to what you have to say in a way that is respectful and courteous:

	Very Often	Sometimes	Rarely	Never	N/A
Appointment Scheduler	*At this office, how often do the following people listen and respond to what you have to say in a way that is respectful and courteous: Appointment Scheduler Very Often	Appointment Scheduler Sometimes	Appointment Scheduler Rarely	Appointment Scheduler Never	Appointment Scheduler N/A
Receptionist	Receptionist Very Often	Receptionist Sometimes	Receptionist Rarely	Receptionist Never	Receptionist N/A
Nurse/MA	Nurse/MA Very Often	Nurse/MA Sometimes	Nurse/MA Rarely	Nurse/MA Never	Nurse/MA N/A
Physician/Provider	Physician/Provider Very Often	Physician/Provider Sometimes	Physician/Provider Rarely	Physician/Provider Never	Physician/Provider N/A
Billing Person	Billing Person Very Often	Billing Person Sometimes	Billing Person Rarely	Billing Person Never	Billing Person N/A

6. Does your doctor or healthcare team explain things in a way that is easy to understand?

Does your doctor or healthcare team explain things in a way that is easy to understand?   Very Often Sometimes Rarely Never N/A

7. Do you feel that our practice and your specialist(s) communicate with each other about important information regarding your care?

Do you feel that our practice and your specialist(s) communicate with each other about important information regarding your care?   Very Often Sometimes Rarely Never N/A

8. Health care can include choices about medicine, surgery or other treatment. In the last 12 months, how often did you feel you were included in decisions about your healthcare choices (care plan)?

Health care can include choices about medicine, surgery or other treatment. In the last 12 months, how often did you feel you were included in decisions about your healthcare choices (care plan)?   Very Often Sometimes Rarely Never N/A

9. How confident are you that you can control and manage most of your health problems?

How confident are you that you can control and manage most of your health problems?   Very Confident Confident Not Confident N/A

10. Would you recommend this practice to your friends and family?

If not, please explain why in the box below.

Would you recommend this practice to your friends and family? If not, please explain why in the box below.   Yes No N/A

If not, please explain why:

11. Are there things about your medical care that could be better?

Are there things about your medical care that could be better?