* 1. Your Appointment

  Poor Fair Good Very Good Excellent N/A
Ease of making appointments by phone
Appointment available within a reasonable amount of time
Getting after-hours care when you need it
The efficiency of the check-in process
Waiting time in the reception area
Waiting time in the exam room
Keeping you informed if your appointment time is delayed
Ease of getting a referral when needed

* 2. Our Staff

  Poor Fair Good Very Good Excellent N/A
The courtesy of the person who took your call
The friendliness and courtesy of the receptionist at the office
The caring concern of our medical assistants
The helpfulness of the people who assisted you with billing or insurance
The professionalism of our lab staff

* 3. Our Communication with You

  Poor Fair Good Very Good Excellent N/A
Phone calls answered promptly
Getting advice or help when needed during office hours
Effectiveness of our health information materials
Our ability to return calls in a timely manner
Your ability to contact us after hours
Your ability to obtain prescription refills by phone

* 4. Do you utilize our patient portal?

* 5. Comments/Suggestion on the Patient Portal

* 6. Your Visit with the Provider

  Poor Fair Good Very Good Excellent N/A
Willingness to listen carefully to you
Taking time to answer your questions
Explaining things in a way you could understand
Instructions regarding medication/follow-up care

* 7. Our Facility

  Poor Fair Good Very Good Excellent N/A
Hours of operation convenient for you
Overall comfort
Adequate parking
Convenience of office location

* 8. Your Overall Satisfaction

  Poor Fair Good Very Good Excellent N/A
Our practice
The quality of your medical care
Overall rating of care from your provider

* 9. Is there an employee or service that you would like to comment on and how they contributed to making this experience a very positive one?

* 10. If there is any way we can improve our services to you, please tell us about it.

* 11. How did you hear about us: please check all that apply

* 12. Some information about you: Gender

* 13. Some information about you: Your Age

* 14. What kind of patient best describes you?

* 15. Would you like someone from SKI to contact you about your experience?