Patient Experience
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1. Who do you see today?

2. In what year were you born? (enter 4-digit birth year; for example, 1976)

3. Please select your gender.

4. I was able to schedule an appointment on the day on the day I wanted.

5. I made a list of my concerns before the visit with my care team.

6. My clinician asked my thoughts on the treatment goals to which we agreed.

7. My questions were answered in a way that I could understand.

8. I was satisfied with the amount of time I spent with my clinician.

9. I was able to see the clinician I requested.

10. My clinician is concerned about me as a person, not just my illness.

11. My care team contacts me to remind me I need to come in for my checkup.

12. I know my rights and responsibilities as a patient at this practice.

13. I am at ease asking questions about my healthcare concerns.

14. My clinician is a good listener.

15. I can manage my health better because of what I learn from my clinician and the care team.

16. My clinician tells me the common side effects for each of my treatment choices.

17. I have a say in decisions about my care.

18. I am notified in a timely manner of test results after I have had lab work and xrays.

19. I am asked about my satisfaction with my healthcare.

20. When I have questions about my bill, my questionsare answered politely.

21. The practice makes information available to me through their website.

22. I can easily get in touch with the practice after regular hours and on weekends.

23. I would refer my family and friends to this practice.

24. What do you like about the practice?

25. What would you improve about the practice?

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