1. Tell Us About Your Visit

Description of Visit

* 1. Did you schedule an appointment for your visit?
(If you came more than once, did you schedule appointments most of the time?)

* 2. How long did you wait to be seen?

* 3. Please rate your interactions with the following people:

  Excellent Good Fair Poor N/A
Nurse Practitioner
Nursing Students
Student Receptionist

* 4. In regard to your expectation for service, would you say that:

* 5. Please rate the following

  Excellent Good Fair Poor N/A
Convenience of Scheduling
Convenience of SHS Location
Convenience of Days Open
Convenience of Hours Open

* 6. Do you feel the provider addresses your concerns?

T