* 1. Was this your first visit with one of our providers/staff?

* 2. How satisfied were you with the following:

  Very Dissatisfied Very Satisfied
Ease of making an appointment
Cleanliness of the offices and rooms
Wait time in the lobby before being seen by service staff/provider
Degree that the service provided met your needs
The confidentiality of your health information

* 3. The service provided today: (select all that apply)