* 1. Are you currently enrolled and receiving VA healthcare?

* 2. Name of your facility

* 3. Is there a problem with scheduling appointments?

* 4. When scheduling appointments are you assigned a doctor?

* 5. If you are not assigned a doctor then who is providing your primary care?

* 6. If you are not assigned a doctor then who is providing your specialty care?

* 7. When arriving at a VA medical facility, are there problems with parking?

* 8. If the facility has valet service, how was your experience with the service?

* 9. Upon arriving at a VA medical facility, were you greeted at the customer service desk?

* 10. When receiving care at a VA medical facility, were nursing assistants courteous?

* 11. When receiving care at a VA medical facility, were nurses courteous?

* 12. When receiving care at a VA medical facility, were doctors courteous?

* 13. When receiving care at a VA medical facility, did doctors listen to your concerns?

* 14. When receiving care at a VA medical facility, did nurses listen to your concerns?

* 15. During your stay at a VA medical facility, did your nurse respond to you in a timely manner?

* 16. When receiving care at a VA medical facility, was information explained well?

* 17. During your stay at a VA medical facility, were the bathrooms clean?

* 18. When receiving medical treatment, did medical instruments appear clean?

* 19. During your stay at a VA medical facility, were the rooms clean?

* 20. During your stay at a VA medical facility, were the hallways quiet around your room?

* 21. During your stay at a VA medical facility, did the rooms have privacy?

* 22. What is your average wait time for a primary care appointment when visiting a VA medical facility?

* 23. What is your average wait time for a specialty care appointment when visiting a VA medical facility?

* 24. What is your average wait time at a pharmacy when visiting a VA medical facility?

* 25. What is your average wait time for beneficiary travel reimbursement when visiting a VA medical facility?

* 26. When receiving beneficiary travel reimbursement, what is the payment type?

* 27. When receiving beneficiary travel reimbursement, what is the average lag time for receiving reimbursement?

* 28. What rating would you give your VA medical center?

* 29. How would you describe your experience with VA health care?

* 30. How satisfied are you with VA health care?

* 31. Have you ever been mistreated while receiving VA health care?

* 32. If so, have you ever filed a complaint?

* 33. Did the facility follow up?

* 34. Satisfied with the outcome?

* 35. Any additional comments?

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