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* 1. Ability to get a timely appointment and courtesy of the staff who scheduled me:

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* 2. Waiting room conditions (please note location in comment section):

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* 3. Appearance of staff:

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* 4. Professionalism, courtesy, and knowledge of staff (please mention any staff by name that were involved in your patient experience):

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* 5. Friendliness of physician (please note which doctor you saw in the comment section):

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* 6. Quality of information and explanation from your physician:

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* 7. Coordination between physician & staff for your care:

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* 8. Instructions explaining what you need to do or what will happen next:

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* 9. Facility neatness and cleanliness:

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* 10. May we contact you for more feedback in the future? 

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