* 1. Availability for Appointment

* 2. Time Spent in Waiting Room

* 3. Time Spent in Exam Room

* 4. Cleaniness of our office

* 5. How was your experience with your healthcare provider?
Do you feel that your healthcare provider explained what you wanted to know, provided a thorough medical exam, offered you good advice and did so in a warm, professional manner?

* 6. How was your experience with our staff?
Do you feel that our front office staff, nursing staff, and billing staff offered you professional and friendly service?

* 7. What do you like best / least about our care team?

* 8. Would you refer us to your friends or relatives?

* 9. Suggestions for Improvement

* 10. Which healthcare provdier did you see?