We know we can do better responding to your health care needs. Your confidential feedback will be used to improve our care and services. There are only 14 easy questions. THANKS!

* 1. In the last 12 months, how often were the receptionists (at the front desk) at Evergreen Family Health as helpful as you thought they should be?

* 2. In the last 12 months, when calling to make an appointment, do you feel the scheduling specialists were as helpful as you thought they should be?

* 3. In the last 12 months, when you made an appointment for the following types of care, how often did you get an appointment as soon as you thought you needed? (if you didn't request a visit type, leave row blank)

  Never Almost Never Sometimes Usually Almost Always Always
Urgent medical need
Routine visit or follow-up care
Health maintenance or "Physical"

* 4. In the last 12 months, when you phoned EVERGREEN FAMILY HEALTH with a medical question DURING REGULAR OFFICE HOURS, how often did you get an answer to your question that same day?

* 5. In the last 12 months, when you phoned Evergreen Family Health AFTER REGULAR OFFICE HOURS, how often did you get an answer to your medical question as soon as you needed?

* 6. Please indicate your personal practitioner, with whom you would typically request a routine visit, a check up, or seek medical advice:

* 7. Over the past 12 months, how often were you able to get an appointment with THIS PRACTITIONER when you requested it?

* 8. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see THIS PRACTITIONER within 15 minutes of your appointment time?

* 9. In the last 12 months, how often did THIS PRACTITIONER spend enough time with you?

* 10. In the last 12 months, did THIS PRACTITIONER explain things in a way that was easy to understand?

* 11. In the last 12 months, did anyone in THIS PRACTITIONER'S office talk with you about specific goals for your health?

* 12. If you smoke, did THIS PRACTITIONER recommend that you quit?

* 13. In the last 12 months, when your practitioner ordered a blood test, x-ray or other test for you, how often did someone from Evergreen Family Health follow up in reasonable time to give you those results?

* 14. Overall how satisfied are you with your experiences at Evergreen Family Health?

 
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