* 1. Which doctor(s) do you see? (Please mark all that apply)

* 2. During a typical office visit, does your doctor spend too much time with you, too little time with you, or about the right amount of time with you?

* 3. How much do you trust your doctor to make medical decisions that are in your best interests?

* 4. How helpful is your doctor at explaining your medical condition(s)?

* 5. How well does your doctor listen to you?

* 6. How quickly does your doctor's staff help you when you need help?

* 7. How friendly is your doctor's office staff?

* 8. Overall, are you satisfied with your doctor, neither satisfied nor dissatisfied with him/her, or dissatisfied with him/her?

* 9. How likely are you to recommend your doctor to family or friends?

* 10. Please take a moment to add any comments, concerns or information that you think could improve your relationship with your doctor or improve your satisfaction with the office staff. Feel free to expand upon any of your answers to previous questions here also.

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