How satisfied are you with the following?

Please choose one for each of the following questions:

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1. Service this survey is about

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2. Which provider are you completing this survey about?

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3. Ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments)?

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4. Ease of making appointments for sickness/dental emergency?

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5. Ease of contacting your doctor when our office is closed (nights and weekends)?

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6. The time it takes someone from our office to respond when you call the office?

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7. Waiting time in our office?

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8. Ease of obtaining follow-up information and care (test results, medicines, care instructions)

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9. Overall care during your appointment?

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10. Our office's appearance?

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11. Our office's convenience (location, parking, hours, office layout)?

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12. The way we teach you about improving your health?

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13. The way your doctor involves other doctors and caregivers in your care when needed?

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