Summerville Survey English Español Question Title * 1. Please select your provider Brittany O'Toole, FNP Question Title * 2. Do you participate in the sliding scale fee discount plan? Yes No Question Title * 3. If you do participate in the sliding scale plan, do you find your sliding scale fees: Affordable Not affordable Not applicable I do not have sliding scale Question Title * 4. If fees are not affordable and you would like to speak with one of our case managers about your sliding scale, please enter in your name and phone number please. Question Title * 5. Insurance Yes No Question Title * 6. Age 0-17 18-35 36-53 54-71 72+ Please select how well you think we are doing. Question Title * 7. EASE OF GETTING CAREScheduling, hours and location Excellent Good Fair Poor Question Title * 8. Scheduling: Friendly, helpful, answered questions. Excellent Good Fair Poor Question Title * 9. FRONT DESKFriendly, helpful, answered questions Excellent Good Fair Poor Question Title * 10. Time spent in the waiting room Excellent Good Fair Poor Question Title * 11. Time spent in the exam room Excellent Good Fair Poor Question Title * 12. STAFFReturn calls, keep you up to date on test results, medications and referrals Excellent Good Fair Poor Question Title * 13. STAFF NURSESFriendly,helpful and answers questions Excellent Good Fair Poor Question Title * 14. PROVIDERListens, takes time, answers questions, provides advice on self-care and treatment options Excellent Good Fair Poor Question Title * 15. PAYMENTCollection of money/payment Excellent Good Fair Poor Question Title * 16. Facility: neat, clean comfort and safety Excellent Good Fair Poor N/A Question Title * 17. Confidentiality:Personal information kept private Excellent Good Fair Poor N/A Question Title * 18. Comments/Suggestions: Question Title * 19. If you would like to speak with someone regarding your visit today, please enter your name and number. One of our team members will reach out to you soon. Thank you! Question Title * 20. Do you use the patient portal? Yes No I don't know what the patient portal is Question Title * 21. If you do not to use the patient portal, please tell us why: You would rather speak to someone on the phone You do not have a smart phone or computer to access the patient portal Not interested in using it Other Question Title * 22. If you would like help using the patient portal, please leave your name and number and we will reach out to you to assist. Done